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What Works III 

Focus on 

School Health in Urban Communities 



1995 CityMatCH Survey 

of 

Urban Maternal and Child Health Programs 



Harry W. Bullerdiek, MPA 

Patrick S. Simpson, MPH 

Magda G. Peck, ScD 



Published by 
CityMatCH 



Jl^^ 



Che as: BuUerdiek, HW, Simpson, PS, Peck, MG (1996). What Works III: J 995 Focus on School 
Health in Urban Communities. Omaha, NE: CityMatCH. 

What Works ni: 1995 Focus on School Health in Urban Communities is not copyrighted. Readers 
are free to duplicate and use all or part of the information contained in this publication. In accordance 
with accepted publishing standards, CityMatCH requests acknowledgment, in print, of any 
information reproduced in another publication. Inclusion of a work in this publication does not infer 
agreement or endorsement of the principles or ideas presented. 

Initiated in 1988, CityMatCH is a national organization of urban maternal and child health leaders 
addres^g the need for increased communication and collaboration among urban maternal and child 
health programs for the purpose of improving planning, deUveiy, and evaluation of maternal and child 
health services at the local level. CityMatCH, through its network of urban health department 
maternal and child health leaders, provides a forum for the exchange of ideas and strategies for 
addressing the health concerns of urban families and children. 

For more information about CityMatCH, contact: 

Magda G. Peck, ScD 

CityMatCH Executive Director/CEO 

University of Nebraska Medical Center 

600 South 42nd Street, Omaha, NE 68198-2170 

Telephone (402) 559-8323 

FAX (402) 559-5355 

E-maU MPECK@UNMC.EDU 



Published by: 

CityMatCH 

at the 

University of Nebraska Medical Center 

600 South 42nd Street 

Omaha, NE 68198-2170 

(402) 559-8323 



Single copies available at no charge from: 
National Maternal and Child Health Clearinghouse 
8201 Greensboro Drive, Suite 600 
McLean, VA 22102 
(703) 821-8955, Ext. 254 

Publication #1-022 



<7^ 



Printed on recycled paper. 



What Works III: School Health in Urban Communities 



Table of Contents 



What Works III: 1995 Focus on School Health in Urban Communities 



List of Figures and Tables 



Preface 

Acknowledgements 

Introduction 



11 



SECTION I 



RESULTS OF THE 1995 CityMatCH SURVEY: 
FOCUS ON SCHOOL HEALTH 

About the 1995 Survey 

- Survey Methods and Response 

- Major Findings 

School Health in Urban Communities 

- Issues in the literature 

- Key definitions 

- Relationships 

- Authority 

- Involvement in Comprehensive School Health Programs 

- Urban Health Departments and School Health Centers 



SECTION n 



SECTION HI 



1 

2 
4 
8 

8 

11 
14 
21 
25 
29 



THE URBAN HEALTH DEPARTMENT/SCHOOL CONNECTION: 
BARRIERS EXPERIENCED IN SCHOOL HEALTH 

- Barriers and Strategies 32 

THE URBAN HEALTH DEPARTMENT/SCHOOL CONNECTION: 
SUCCESS STORIES IN SCHOOL HEALTH 

- Summary Grid of Initiatives 70 

- Initiative Profiles 73 



SECTION IV 



APPENDICES 

- Survey Instrument 

- List of Surveyed Health Departments 

- Directory of Urban MCH Programs and Leadership 

- Urban Health Department Involvement With School-Based Health Centers 

- Urban Health Department Involvement With School-Linked Health Centers 

- Urban Health Department Services Provided (by Category) As Lead Agency 

- Publications/Resources Reviewed 



What Works m: SdKwI Health in Ufban Communities 



Figures and Tables 



Figures 

Figure 1 Percent Distribution of Survey Responses by Urban Health 
Department by Population Category 

Figure 2 Barriers to Collaboration on Comprehensive School Health 
Services Experienced by Urban Health Departments 

Figure 3 Health Department Relationships with Schools in 
Jurisdiction for Assurance Activity 

Figure 4 Health Department Involvement in Assurance-Related 
School Health Activities 

Figure 5 Comparison ofUrban Health Departments Reported Health 
Services Delivery Arrangements with Schools 

Figure 6 Urban Health Department Level of Relationship with Schools 
on Needs Assessment/Planning Activities 

Figure 7 Urban Health Departments Level of Involvement 
with Schools on Policy Development Activities 

Figure 8 Formality of Relationships Between Urban Health Departments 
and Schools in Jurisdiction 



15 



18 



19 



20 



21 



23 



Figure 9 Urban Health Department Involvement with Schools by Grade 
Level for Health Services 



26 



Figure 10 Distribution of Urban Health Department Involvement with 
Services Provided to High Schools 

Figure 11 Mental Health Services Provided by Urban Health Departments 
by Grrade Level 



27 



28 



What W(m1cs m: School Health in Urban Communities 



Figures and Tables 



Tables 



Table 1 1995 CityMatCH Survey Response by Population of 

Urban Health Department Jurisdictions 

Table 2 Reported Relationships Between Urban Health 
Departments and Schools: Assurance 

Table 3 Level of Urban Health Department Relationships with Schools 
for Assurance Activities 



16 



17 



Table 4 Reported Relationships Between Urban Health 
Departments and Schools: Assessment Functions 

Table 5 Level of Urban Health Department Relationships with Schools 
for Assessment Activities 



20 



21 



Table 6 Reported Relationships Between Urban Health 
Departments and Schools: Policy Development 

Table 7 Level of Urban Health Department Relationships with Schools 
for Policy Development Activities 

Table 8 Health Departments Involvement with Schools Mandated by 
Law or Formalized Through Memorandum of Understanding 
or Contract 



22 



22 



24 



Table 9 Percent of Urban Health Departments Reporting Involvement 
in Comprehensive School Health Programs by Component 

Table 10 Barriers to Collaboration with Schools Encountered by 
Responding Urban Health Departments 



26 



33 



What Works III: Sdiool Health in Urban Communities 

PREFACE 

Maternal and child health programs in city and county health departments nationwide are key players in the 
development, assurance, monitoring and assessment of health-related services for urban children and their 
families. Their specific roles and efforts in school health at the local level is less well known. Education and 
health are natural partners at the local level; this partnership is critical in America's cities. 

This document builds upon a basic CityMatCH premise that urban health departments have much to teach 
and learn fi-om each other. The CityMatCH strategy is to provide a timely, eflBcient mechanism for 
communication and collaboration across America's cities to promote the exchange of information about what 
works, what doesn't, and why. 

What Works III: 1995 Focus on School Health in Urban Communities is the third in a series of documents 
published by CityMatCH under our Partnership for Information and Communication Cooperative Agreement 
with the Maternal and Child Health Bureau, the "Municipal MCH Partners Project" (MCU#3 16058-04-0). 
We challenge urban MCH directors and others in the field to use the information fi-om our surveys to shape 
effective solutions to shared urban MCH problems. 



Magda G. Peck, ScD 
Executive Director/CEO 
CityMatCH 



What Works III: School Health in Uiban C(»nmunities 

ACKNOWLEDGEMENTS 

What Works III: 1995 Focus on School Health in Urban Communities represents the efforts of many 
individuals who worked closely together in the design, implementation, analysis, and dissemination of the 
1995 CityMatCH survey of urban maternal and child health. Colleagues on the "Municipal MCH Partners 
Project" Advisory Committee helped to define the focus on school health and gave the survey its meaning. 
Public health leaders fi-om the National Association of County and City Health OflScials, the Association of 
Maternal and Child Health Programs, the Association of State and Territorial Health Officials, and the 
Maternal and Child Health Bureau, worked closely with urban MCH leaders fi^om CityMatCH to ask the 
right questions about school health in urban communities. Particular thanks to Drs. Paul Melinkovich and 
Edward Ehlinger for shaping the survey instrument. 

CityMatCH staff rallied for this one. Project Coordinator Harry BuUerdiek lent a lead editorial hand and 
marshaled the troops to get the study fi^om data to product. In his first days with CityMatCH, Project 
Coordinator Patrick Simpson jumped into the middle of the analysis and writing, picking up fi-om the 
dedicated efforts of CityMatCH staff Elice Hubbert, who launched the study and oversaw initial data 
collection and analysis, and Christina Kerby who helped with data entry and analysis. Data analyst Fred 
Ullrich again lent his programming wizardry. Project Coordinator Dan Koenig took on the MCH Initiatives 
in Section HI, bringing fi-esh editing and journalism skills to the final product. Administrative Technician Joan 
Rostermundt helped with survey administration and document dissemination. The secretarial support of Diana 
Fisaga and Phyllis Coleman proved essential for quality and outputs. Mark Watson and Joe Edwards of the 
University of Nd)raska Medical Center Printing and Biomedical Communications facilitated final production. 

Last, the tremendous participation of urban MCH leaders in city and county health departments nationwide 
must be acknowledged. Nearly 85 percent of those surveyed shared their ideas, experiences and knowledge 
about linkages between health and education in urban communities. That so many offered crucial information 
not only adds to the validity of the data in this document, but demonstrates again urban MCH leaders' 
commitment to improving the health and well-being of children and families who call America's cities "home." 



What Works III: Sdiool Health in Urban Communities Introduction 

INTRODUCTION 

Whit Works III: J 995 Focus on School Health in Urban Communities is a tool to inform and assist urban 
public health practitioners and others interested in urban maternal and child health (MCH). It provides a 
topical reference on school health issues in urban areas from the perspective of the local health department, 
based on the results from the 1995 CityMatCH Survey of Urban Maternal and Child Health Programs. 

Section I: Results of the 1995 CityMatCH Survey 
About the 1995 Survey provides an overview of the background, purposes, and methodology used in 
conducting and analyzing the survey. Major findings are highlighted. Focus on School Health in Urban 
Communities first discusses issues found in the literature, the framework and key definitions. The 
connection between urban health departments and schools, areas and level of involvement, and the 
legal/formal foundation of these relationships are more fully explored. 

Section It: The Urban Health Department/School Connection: 
Barriers Experienced in School Health 

This section provides a glimpse into the obstacles urban health departments are encountering as they 
increasingly become involved in school health. These obstacles are divided into four categories. Attitudes, 
Resources, Society and Systems, so the reader can quickly find ideas and strategies used by others in similar 
situations. 

Section HI: The Urban Health Department/School Connection: 
Success Stories in School Health 

Responding urban health departments were asked to provide a profile of a current effort or innovation to 
share with their colleagues across the United States. This section includes a summary of characteristics and 
contact information for those interested in follow-up and/or replication. Funding levels and flinding sources 
for MCH programs are identified and presented in an easy "at-a-glace" summary table. 



ui 



What Works ni: SdKM>l Heahfa in Urban Oxmnunhies Introduction 

Section IV: Appendices 

Appendices include the survey instrument, list of responding health departments, and a directory of Urban 
MCH Programs and leadership. Also included are tables showing urban health department involvement with 
school-based health centers and school-linked health centers by federal region, noting number of health 
centers in jurisdiction, grade level (elementary, middle or high school) and whether or not they identified 
themselves as the lead agency. The final table lists the categorical services provided (medical, health 
education, mental health, social services) at school health centers where urban health departments identified 
themselves as the lead agency. 



m 






IV 



RESULTS 
OF THE 
1995 

CityMatCH 
SURVEY 



SECTION I 



FOCUS 

ON 

SCHOOL 

HEALTH 



What Works III: Sdiool Health in Ufban Communities Section I 

ABOUT THE 1995 SURVEY 

What Works III: 1995 Focus on School Health in Urban Communities, the third publication in the 
CityMatCH WhcU Works series, is based upon information gathered from city and county health departments 
across the country in response to the fifth national survey of health department-based maternal and child 
health (MCH) programs in the largest cities in the United States. The CityMatCH What Works publications 
are a multiple use, information resource for urban pubUc health practitioners and others interested in maternal 
and child health programs at the local level. Each edition of What Works has provided city-specific 
"snapshots" of MCH programs in local health departments in America's most populated urban areas. The 
publication includes a directory listing the name, address, and phone number for the MCH program leader 
in each of the 173 health department jurisdictions targeted by CityMatCH.^ In addition, profiles of urban 
health department initiatives on specific topics such as immunization, prenatal care, infant mortality, and 
children's health are included. 

The annual CityMatCH urban MCH survey is a core activity of the "Municipal MCH Partners Project," the 
CityMatCH Partnership for Information and Communication (PIC) Cooperative Agreement (MCU #3 1605 8- 
04-0) with the Federal Maternal and Child Health Bureau (MCHB). The 1995 survey focused on school 
health, with two principal purposes: 1) to gather general information about the links between health 
departments and schools in urban communities including the level and types of health department involvement 
in school health, the organization, funding, and authority for school health activities, and information about 
barriers preventing school collaboration and efforts at overcoming them; and 2) to obtain examples of current 
urban health department initiatives and activities relating to school health. 



What Works III: School Health in Urban Communities 



Secti<»I 



Survey Methods and Response 

A 12- page questionnaire was mailed to 173 targeted health departments who, according to the 1990 U.S. 
Census, had one or more cities within their jurisdiction with central city populations of 100,000 or more. This 
includes San Juan, Puerto Rico and other health departments serving the largest cities in the states not 
otherwise represented. The first mailing was in December 1994, with two subsequent mailings and 
FAX/telephone follow-up though April 1995. An overall health department response rate of 84 percent (145) 
was achieved. North Dakota, Rhode Island, South Carolina and Wyoming are not represented. Responses 
were received fi"om 100 percent (27) of health departments serving cities with central city populations greater 
than 500,000. 



Table 1. 1995 CityMatCH Survey 

Response by Population ofUrban Health Department (UHD) Jurisdictions 


;||||||||||j|g^ 


Number of UHDs 
Surveyed 


Number of UHDs 
Responding 


Response Within 
Population Categories 


under 200,000 


94 


75 


80% 


200,001 to 300,000 


25 


18 


72% 


300,001 to 500.000 


27 


25 


93% 


500,001 to 800,000 


15 


15 


100% 


greater than 800,000 


12 


12 


100% 


TOTAL 


173 


145 


84% 



Combined population of ail central cities greater than 100,000 witliin liealtli department jurisdiction. 



WhiU Woiks m: School Health in Urban Communities 



Section I 



Population categories used in the analysis represent the combined population of all central cities with 
populations greater than 100,000 within the health department jurisdiction. The population actually served 
by the health department may be larger and include non-uiban areas. Cities listed in this report are where the 
responding health department is located, hence the city's actual population may be smaller than the assigned 
population category. For example, the health department located in Santa Ana, CA, (population 293,742) 
also serves Anaheim, FuUerton, Garden Grove, Huntington Beach, Irvine and Orange, CA, which places it 
in the 500,001-800,000 population category. Figure 1 (below) shows the distribution of responses by 
population category. 



1995 ChyMatCH Survey Responses 



52% 



13% 




17% 



Population Cat^oiy 

H <200,000 nU 200,001-300,000 
□ 300,001-500,000 H 500,001-800,000 
^ >800,000 



Figure 1. Percent Distribution of Survey 
Responses by Urban Health 
Department by Population Category 



What Works III: School Heahh in Uiban C(Mninuiiities Section I 

Major Findings 

Relationships 

Between 

Urban Health Departments 

and Schools 

o Neaiiy all of the 145 urban health departments responding to the CityMatCH survey reported some 

relationship with a public, non-public, and/or alternative school(s) within their jurisdictions. Only 2 
percent (3) did not indicate any school relationship. 

o Overall, urban health departments are more likely to have relationships v^th public schools than with 

non-public or other/alternative schools, particularly in the delivery of health services. Health 
departments usually provide health services to public schools on a direct rather than contractual basis, 
and the relationship described is more often "on-going" in nature than "on-request." 

o Urban health department activities in schools often are related to the three "core public health 

fiinctions" of assessment, assurance, and policy development.^ The assurance-related fimctions of 
collaboration on special projects and provision of technical assistance or training for faculty, staff, and 
parent groups were the two most often reported relationships for all types of schools. 

o Most urban health departments reported assisting public schools with monitoring and assessment 

activities. Relationships which involved monitoring activities usually were described as on-going. 
Relationships which involved needs assessment or planning for services were divided equally between 
an on-going or on-request basis. 

o Urban health departments reported being much more likely to participate in policy development 

activities in public schools than in other types of schools. This activity was usually on an on-request 
basis. 

o Of all activities in which urban health depeirtments engage in with non-public and other/alternative 

schools, regulation, inspection, and certification activities are those most likely to be carried on an 
on-going basis rather than on-request. Health department relationships with non-public schools and 
other/alternative schools are similar to one another. 



1 



What Works ni: School Heahh in Uiban Communities 



Section I 



Authority for 

Urban Health Department 

Involvement 

With Schools 

Responding urban health departments involvement Avith school districts can be through Memorandums of 

Understanding, legislation, formal contracts, or a combination of legal instruments. 

o Nearly 50 percent of responding urban health departments indicated their involvement with schools 

in their jurisdictions was mandated by law and/or formalized through a written agreement. 

Urban Health Departments 

and Comprehensive 

School Health Programs 

Urban health departments reported varying levels of involvement in the eight categories of school health 

services at elementary, middle, and high schools.^ 

o Urban health departments most often were involved in the health services component of 

comprehensive school health programs across all grade levels, averaging 66 percent across grade 
levels. Most frequently mentioned services included screenings, immunizations, physicals, and first 
aid. Health education and community involvement were the next most engaged in activities. Physical 
education was consistently ranked at the bottom of activity involvement for heahh departments at all 
grade levels. In general, the amount of involvement in each area was steady across all grade levels. 

Urban Health Departments 

and 
School Health Centers 

School health centers can be divided into two groups: school-based health centers (SBHCs) and school-linked 
health centers (SLHCs). SBHCs are located on school grounds and serve only that school. SLHCs can be 
located on a school campus and serve more than one school or can be located off the school campus, 
regardless of the number of schools served.^ 



School-based Health Centers 

o Fifty-five percent (79) of responding urban health departments indicated that one or more SBHCs 

were located within their jurisdictions; a total of 334 SBHCs in all. Fifty-three percent (177) of 
SBHCs were located in high schools and 13 percent (43) were in middle schools. 



What Wwks HI: School Health in Uihan Communities Section I 

o Only 17 percent (13) of urban health departments with SBHCs in their jurisdictions reported they had 

no involvement with any SBHCs. Seventy-two percent (57) reported they were involved with all the 
SBHCs in the jurisdiction, and of these, more than 35 percent (20) indicated they were the lead 
agency for all SBHCs within their jurisdiction. 

See Appendix D, for a listing of all urban health departments who reported SBHCs in their jurisdictions and 
information regarding the health department's level of involvement in SBHCs. 

School-Linked Health Centers 

o Thirty percent (44) of responding urban health departments indicated that one or more SLHCs were 
located within their jurisdictions; a total of 190 SBHCs. Fifty-five percent (105) of SLHCs were 
located in high schools; twenty percent (38) were in middle schools. 

o Thirty-nine percent (17) of health departments who reported the location of SLHCs in their 

jurisdictions said they had no involvement with any SLHCs. Another 43 percent (19) reported they 
were involved with all the SLHCs in the jurisdiction, and of these, 58 percent (1 1) indicated they were 
the lead agency. 

See Appendix E, for a table of urban health departments with SLHCs in their jurisdictions and information 
regarding each health department's level of involvement. Eighteen percent (26) of jurisdictions reported the 
existence of both SBHCs and SLHCs. 



Services Provided by Urban Health Departments in SBHCs and SLHCs 

o The services most often provided by urban health departments in a SBHC or SLHC setting were 

identified as health education services [SBHC~72 percent (57), SLHC~84 percent (37)] and medical 
services [SBHC~71 percent (56), SLHC~80 percent (35)]. 

o Mental health services and social services were provided by less than half of the urban health 
departments. 

See Appendix F, for a city-specific listing of the types of services provided in SBHCs and/or SLHCs by 
urban health departments that identified themselves as the lead agency. 



What Woiics III: School Health in Uiban Communities 



Section I 

Barriers 

to Collaboration 

and Efforts 

to Overcome Them 



Barriers experienced by urban health departments trying to work in collaboration with schools in their 
jurisdictions were divided into four main categories: (1) resource barriers such as lack of funding, lack of 
staff, and lack of time; (2) systems barriers such as bureaucracy and difficulty coordinating services and 
information sharing across multiple sites; (3) attitudinal barriers including turf battles, low prioritization, 
and role confusion; and (4) societal barriers especially related to issues of sexuality and family planning.^ 

A wide variety of efforts have been directed at overcoming obstructions with varying amounts of success. 
Unique social, political, and economic factors in each jurisdiction ultimately impact attempts at collaboration. 
There is no "one right way" to overcome the barriers to school health collaboration, rather a combination of 
pragmatic approaches and perseverance are key. Strategies reported by urban health departments to 
overcome obstacles include the following; 



Pursue both individual and group dialogue to 
clarify issues and build broad- based support for 
school health services. 

Identify key individuals in the school system and 
health department to facilitate the coordination of 
services. 

Create and support structures to promote 
collaboration. 



"Persistence, 



Tenacity, 
Diplomacy." 



Embodying a commitment to 
compreiiensive school health - one 
urban health department's response 
to barriers encountered 



While the various strategies to overcome barriers to collaboration described by responding urban health 
departments are generally consistent with recommended approaches for successful collaboration, they fall 
short of the principles to link by outlined in the consensus document Integrating Education, Health and 
Human Services for Children, Youth and Families.^ There were numerous examples were system needs 
reigned over family needs. Access to a comprehensive continuum of services is not possible when clinics 
close at the end of the school year or are available only to elementary grades. Communities need stable 



What Works m: Scfaool Heahfa in Uiban Communities 



Section I 



funding sources that are flexible enough to meet their needs and promote intra-agency and interagency 
decision making. Needs assessment, program development and evaluation should be part of an ongoing 
process of service provision. Figure 2 shows the distribution of barriers among the four categories 
experienced by urban health departments during thdr efforts in collaboration on comprehensive school health 
systems. For more detail on what health departments experienced and how they responded, see Section II, 
Barriers Experienced in School Health (page 32). 



Percent Distribation of Barriers Experienced by 
Urban HealA Departments 



36% 



2aK 




16K 



21% 



Barrier Category 
M Reaources [jjj Systems 
I I Attitudes |^ Societal 



Figure 2. Barriers to Collaboration on 

Comprehensive School Health Services 
Experienced by Urban Health 
Departments 

School 

Health 

Initiatives 

There are numerous examples of successful initiatives undertaken by urban health departments in the area 
of school health. Urban health departments said they were engaged in education and prevention activities, 
screening, participation in school clinics and health centers, counseling and social services activities, and 
community collaborations, to name a few. An index of each responding community's most innovative practice 
in the link between public health and school health can be found on pages 70-73. 



What Woiks IH: School Health in UriMin Ccmnnunities Section I 

Focus on School Health in Urban Communities: 
Part 1 of the 1995 Survey 

Part 1 of the 1995 CityMatCH survey focused on school health in urban communities. Each health 

department was asked to provide information about its current involvement (as of December 1994) with the 

schools in its community. Questions focused on: 

o the relationships between urban health departments and schools 

o the level of health department involvement with schools 

o sources of authority for health department/school relationships 

o principal areas of involvement 

o barriers preventing effective relationships with schools, and 

o how health departments were attempting to overcome these barriers. 

Each health department was also asked to describe its most successful initiative or activity involving school 

health. 

Issues in the Literature 

Local health departments and schools in their jurisdictions have more than a century of interaction. In the 
1890s in many American cities, physicians first proposed that schoolchildren be given medical inspections, 
vaccinations and hygiene instruction. Spurred on by advances in medicine, emerging local health departments 
and increased foreign immigration to urban communities, a new era of social reform began. ^ The practice 
of school-based medical examinations expanded to 312 U.S. cities by 1910 and to most cities with large 
numbers of immigrants by 1920. Health departments were early players in school health. Into the 20th 
century, health and social services became imbedded in many urban school systems as student services started 
to be applied universally. While public schools developed and maintained their own non-teaching personnel 
to implement health and social services, many state and local health departments built and sustained parallel 
programs for at-risk school-aged children. In examining new fi-ontiers of school health services, Dryfoos 
observes that "one hundred years later, as new groups of immigrants move into disadvantaged communities, 
health agencies are returning to schools to provide health services to needy children and their families." Four 
diverse strategies drive a revitalized movement to address health in schools: adolescent health focus, school 
reform, family self-suflBciency, and the integration of categorical programs into comprehensive programs.* 



What Works ID: Sdiool Heahh in Urban Communities Section I 

While h is largely recognized that integrated school health services are community-based,' and local health 
departments in urban communities are an essential part of the fabric of community-based services, the current 
role of urban health departments in school health is not well known. Most recent conversations between the 
education and health sectors concerning school health are taking place largely at the federal and state levels. 
According to the Joint Statement on School Health Issues by the Secretaries of Education and Health and 
Human Services, health and education are joined in fundamental ways with each other and with the destiny 
of the Nation's children. To help children meet the educational and health and developmental challenges that 
affect their lives, education and health must be linked in partnership. ^° A variety of federal and private funded 
school health initiatives, with particular focus on school-based health care services, have flourished. The 
Centers for Disease Control and Prevention, Division of Adolescent and School Health (CDC/DASH) 1995 
Conference on School Health highlighted the challenges faced by state health and education agencies in 
developing and implementing comprehensive school health programs, and identified strategies for 
collaborative relationships. The Association of State and Territorial Heahh Officials (ASTHO), with 
CDC/DASH and Maternal and Child Health Bureau/Health Resources and Services Administration 
(MCHB/HRSA) funding, surveyed state agencies about comprehensive school health programs as part of 
a continuing effort to identify needs and resources for the development of comprehensive school based 
programs." Specific to SBHCs, states have been a principal conduit for information about program planning, 
financing, policies and technical assistance.*^ 

What works in school health in urban communities? School-based health centers have been found to improve 
children's access to health care by removing both financial and nonfinancial barriers in the existing health care 
delivoy system, by being more convenient for students and parents, and by better meeting the special needs 
of adolescents." Many school-based health centers are in urban communities. *'* Other successful approaches 
are profiled in a 1993 compendium of school health programs produced on behalf of the National 
Coordinating Committee on School Health. Many of the 64 school-based or school-linked evaluated 
initiatives profiled, which targeted kindergarten through college students for health and/or educational 
outcomes and which included at least one of the eight components of a comprehensive school health 
program, are uri>an based. *^ While urban health department programs have not been catalogued 
comprehensively, the successful experiences fi^om selected cities like Boston, MA, and Portland, OR, have 
been described in local reports,'^ and profiles of successful urban school health initiatives have been collected 

10 



What Works m: School Health in Urban Cmnmunities Section I 

by CityMatCH through its annual conference since 1993.'^ 

In America's cities, local health departments are key players in school health. School-based health centers 
are an increasing part of the landscape of primary health care delivery in urban communities. SBHCs and 
other urban school health initiatives rely upon local public health department advocacy and support to 
maximize local and state revenues in an era of managed care and health reform.^* The experiences in Boston, 
MA, and Baltimore, MD, serve to illustrate the essential role of local health departments. The 1995 
CityMatCH Survey of Urban MCH focused on the links between the local education and health sectors to 
address gaps in information about this essential connection. What Works III seeks to add to the limited 
knowledge base of local level activities by systematically identifying promising efforts in the field. 

Key Definitions 

This report uses many different concepts when discussing urban public health activities and comprehensive 
school health issues. For clarity, we are providing below the definitions we used in the development and 
analysis of this study. 

The Bureau of the Census defines "urbanized areas" by population density, each includes a central city and 
the surrounding closely setded urban fiinge (suburbs) that together have a population of 50,000 or more with 
a population density generally exceeding 1,000 people per square mile. "City" refers to an incorporated place 
with a 1990 population of 25,000 or more. The central city or cities in a Metropolitan Statistical Area (MSA) 
are; a.) the city with the largest population in the MSA; b.) each additional city with a population of at least 
250,000 or with at least 100,000 persons working within its limits; c.) each additional city with a population 
of at least 25,000, an employment/residence ratio of at least 0.75 and out commuting of less than 60 percent 
of its resident employed workers; or d.) each additional city of 15,000 to 25,000 population that is at least 
one-third as large as the largest central city, has an employment/residence ratio of at least 0.75 and out 
commuting of less than 60 percent of its resident employed workers*'. This survey targeted urban health 
departments serving central cities with populations greater than 100,000. Some of the surveyed urban health 
department jurisdictions included more than one central city over 100,000 in population and were adjusted 
accordingly to allow for comparison. 



11 



What Wcnks III: Sdiool Health in Urban Communities Secticm I 

Public health's core functions of assurance, assessment and policy development, as defined in the Institute 
of Medicine's 1988 publication The Future of Public Health, provides the basis for much of the current 
research and reorganizational efforts found in America's urban health departments. 



Assurance - that public health agencies assure their constituents that services necessary to 
achieve agreed upon goals are provided, either by encouraging actions by other entities, by 
requiring action through regulation, or by providing services directly. 

Assessment- that every public health agency regularly and systematically collect, assemble, 
analyze and make available information on the health of the community, including health 
status, community health needs, and epidemiologic and other studies of health problems. 

Policy Development - that every public health agency exercise its responsibility to serve the 
public interest in the development of comprehensive public health policies by promoting the 
use of the scientific knowledge base in decision-making about public health and by leading in 
developing public health policy. Agencies must take a strategic approach, developed on the 
basis of a positive appreciation for the democratic political process. 



Policy development and leadership should foster local involvement, emphasize local needs, advocate equitable 
distribution of public resources and complementary activities commensurate with community needs. 
Assurance focuses on protection of the community and the availability of high-quality services for all persons. 

Effectively meeting the broad spectrum of children's health needs in a school setting requires a comprehensive 
approach.^" For a school health program to be truly comprehensive, it should incorporate eight key 
elements:^^ 



Health Education - A planned, sequential instructional program that addresses the physical, 
mental, emotional, and social dimensions of health and motivates students to improve their 
health, prevent disease, and reduce health-related risk behaviors. 

Health Services - Services which insure access or referral to primary health care services, 
foster appropriate use of primary health care, prevent and control communicable diseases, and 
provide emergency care. 

Counseling and Psychological Services - Services which benefit the mental, emotional, and 
social health of students. 



12 



What Woiks III: School Health in UHmii Communities Section I 

• Healthy School Environment - Services which maintain the physical and aesthetic 
surroundings and the psycho-social climate and culture of the school to maximize the health 
of students and staff. 

• Nutrition Services - Services which promote the health and education of students by 
providing access to nutritious and appealing meals. 

• Physical Education - Age-appropriate, sequential programs that promote cognitive content 
and learning experiences in a variety of activity areas which further each student's optimum 
physical, mental, emotional, and social development and build interests and skills students can 
pursue throughout their lives to improve their overall health status. 

• Health Promotion for Staff" - Programs which encourage and motivate school staff to pursue 
healthy lifestyles promoting better health, improved morale, and greater personal commitment 
to the school's comprehensive health program. 

• Community Involvement - Fostering a dynamic, integrated school, parent, and community 
partnership to enhance the health and well-being of students. 

The need for a comprehensive philosophy of school health extends not just to the services provided, but to 
grade levels as well. The eight aspects of comprehensive school health are important to the health of children 
of all ages, from pre-school to high school and beyond.^ 



Coming out of a national symposium on urban school reform, health and safety, Korber identified four major 
categorical barriers encountered by agencies and individuals working to improve our nations schools and 
communities. Caring Schools, Caring Communities: An Urban Blueprint for Comprehensive School Health 
and Safety (1993) listed individual attitudes, limited resources, societal taboos and the very systems we have 
created as barriers to miproving service to children. 



Attitude- Commonly held attitudes that block or inhibit action. This ranges from seeing no 
gain for the effort required to setting poor examples or failing to provide essential prevention, 
care and treatment (not my job). Single approach quick fixes, categorizing problems 
according to genders (missing half of the equation). 

Resources/Funding- Inadequate and outmoded facilities, lack of fiscal support, lack of skilled 
people, time constraints and technology. 



13 



What Works m: School Heahh in Urban Communities Section I 

• Societal - In many communities there are barriers to full and realistic public discussion of 
problems related to sex education and family planning. There is difficulty in overcoming 
current society messages condoning sex and violence. 

• School System - Policies and procedures that undermine comprehensive health education and 
promotion. The political-will to take on difficult issues. Lacking knowledge of the issues and 
strategies to address them. 



Relationships 

In the current school year, [1994-1995] 

what types of relationships does your 

health department have with the schools 

within its jurisdiction? 

Relationships between health departments and schools in urban communities show much variation. Urban 
health departments are engaged in a variety of activities with schools, often related to the three core public 
health fimctions of assurance, monitoring and assessment, and policy development. Table 2 and Table 4 list 
common activities involving public schools, private schools, and/or alternative schools. Where relationships 
exist, activities can be on-going or on request as seen in Table 3 and Table 5. Although the survey results 
do not reveal a "typical" relationship, virtually all responding health departments had some relationship with 
a school or schools in their jurisdictions. Of the 145 responding health departments only two percent (3) 
reported no school relationship of any kind. 

Urban Health Departments and Assurance 

Urban health departments indicated their involvement with schools often includes assurance-related activities. 
Of the six assurance activities listed in Table 2 and Table 3, collaboration on special projects and providing 
technical assistance and/or staff training, are engaged in most often. As seen in Figure 3 and Table 2, this is 
true for public, non-public, and alternative schools. 



14 



What Works III: School Health in Urban Communities 



Section I 



Percent Urban Health Departments Reporting 
Collaboration on Special Projects with Schoob 



100 



^ 60 




School System 

^ Public 

I I NcHi-Public 

fin Other/Alternative 



Figure 3. Health Department Relationships with 
Schools in Jurisdiction for Assurance 
Activity 



In relationships with public schools, collaboration on special projects is usually on-going [59 percent (82)] 
rather than on request [38 percent (53)]. In non-public and alternative schools, the relationship is more likely 
to be on request [non-public: 76 percent (83) on-request vs. 24 percent (26) on-going; alternative: 67 percent 
(60) on-request vs. 30 percent (27) on-going]. Technical assistance is more likely to be provided on request 
in all three types of schools: 65 percent (84) on-request for public and 83 percent (91) for non-public; 27 
percent (35) and 15 percent (16) on-going, respectively. In alternative/other schools the relationship is also 
usually on request 86 percent (83) and 9 percent (9) on-going. 



15 



What Woiics IK: Sdiool Health in Urban Communities Section I 

Table 2. Reported Relationships Between Urban Health Departments and Schools: Assurance 



iiiiiiiisiuHc 
IIIIIJlllyN 


PiMc 
Schools 


Non-Pubfici|i||||| 
Schop|S;|i|i|ii|-^-^--- 


Other/ 

Alternative 

Schools 


Regulation, inspection and/or Certification 


(145) 


(145) 


(145) 


Relationship 


61% 


(89) 


57% (82) 


48% (70) 


No Relationship 


33% 


(48) 


31% (45) 


37% (54) 


Unknown 


6% 


(8) 


12% (18) 


15% (21) 


Technical Assistance and/or Training Staff 


(145) 


(145) 


(145) 


Relationship 


90% 


(130) 


76% (110) 


67% (97) 


No Relationship 


8% 


(12) 


17% (25) 


23% (33) 


Unknown 


2% 


(3) 


7% (10) 


10% (15) 


Assist With Curriculum Development 


(145) 


(145) 


(145) 


Relationship 


61% 


(88) 


42% (61) 


39% (57) 


No Relationship 


35% 


(51) 


48% (69) 


46% (67) 


Unknown 


4% 


(6) 


10% (15) 


15% (21) 


Health Services Delivery Under Contract 


(145) 


(145) 


(145) 


Relationship 


47% 


(68) 


27% (39) 


24% (35) 


No Relationship 


43% 


(62) 


56% (81) 


55% (80) 


Unknown 


10% 


(15) 


17% (25) 


21% (30) 


Direct Health Services Delivery 


(145) 


(145) 


(145) 


Relationship 


69% 


(100) 


48% (69) 


45% (65) 


No Relationship 


23% 


(33) 


40% (58) 


41% (59) 


Unknown 


8% 


( 12) 


12% (18) 


15% (21) 


Collaboration on Special Projects 


(145) 


(145) 


(145) 


Relationship 


96% 


(139) 


75% (109) 


61% (89) 


No Relationship 


1% 


( 2) 


14% ( 20) 


25% (36) 


Unknown 


3% 


( 4) 


11% ( 16) 


14% (20) 



I 



( ) number of responses. 



16 



What Works IH: School Health in Urban Communities 



Section I 



Table 3. Level of Urban Health Department Relationships with Schools for Assurance Activities* 




ASSURANCE 
FUNCTIONS 


Public 
Schools 


Non-Public 
Schools 


Other/ 

Alternative 

Schools 


Regulation, Inspection and/or Certification 


(89) 


(82) 


(70) 


On-Going 


83% 


(74) 


67% 


(55) 


70% (49) 


On Request 


14% 


(12) 


31% 


(25) 


27% (19) 


Both 


3% 


(3) 


2% 


(2) 


3% ( 2) 


Technical Assistance and/or Training Staff 


(130) 


(110) 


(97) 


On-Going 


27% 


(35) 


14% 


(16) 


9% ( 9) 


On Request 


65% 


(84) 


83% 


(91) 


86% (83) 


Both 


8% 


(11) 


3% 


(3) 


5% ( 5) 


Assist With Curriculum Development 


(88) 


(61) 


(57) 


On-Going 


24% 


(21) 


8% 


(5) 


5% ( 3) 


On Request 


74% 


(65) 


92% 


(56) 


93% (53) 


Both 


2% 


(2) 


0% 


(0) 


2% ( 1) 


Health Services Delivery Under Contract 


(68) 


(39) 


(35) 


On-Going 


71% 


(48) 


36% 


(14) 


37% (13) 


On Request 


25% 


(17) 


62% 


(24) 


60% (21) 


Both 


4% 


(3) 


2% 


( 1) 


3% ( 1) 


Direct Health Services Delivery 


(100) 


(69) 


(65) 


On-Going 


66% 


(66) 


32% 


(22) 


34% (22) 


On Request 


29% 


(29) 


67% 


(46) 


63% (41) 


Both 


5% 


(5) 


1% 


( 1) 


3% ( 2) 


Collaboration on Special Projects 


(139) 


(109) 


(89) 


On-Going 


59% 


(82) 


24% 


(26) 


30% (27) 


On Request 


38% 


(53) 


76% 


(83) 


67% (60) 


Both 


3% 


(4) 


0% 


(0) 


2% ( 2) 



* Urban health departments reporting a relationship (See Table 2) for assurance activities. 

( ) number of responses. 



17 



What Works ID: School Health m Urban Communities 



Section I 



Twenty-nine percent (29) of responding urban health departments indicated that direct health services were 
provided on-request to public schools. Direct health services are provided by health departments in non- 
public and other/alternative schools, but in contrast to public schools, these relationships were more likely 
to be on-request. Figure 4, shows the frequency of reported health department involvement in the six 
assurance-related school health activities with public schools in their jurisdiction. 



4 



< 



Percent Urban Health Departments Reporting 
Assurance-Related Activities in Public Schools 

Collaboration on Special Projects 

Technical Assistance/Staff Training 

Direct Health Service E>elivery 

Regulation, Inspection, Certification 

Assist with Curriculum Development 

Health Services Delivery Undar Contract 

20 40 60 80 100 
Percent 




Figure 4. Health Department Involvement in 
Assurance-Related School Health 
Activities 



Relationships involving health services delivery are also common. As can be seen in Figure 5, direct health 
services delivery is reported more often than health services delivery under contract. Sixty-six percent (66) 
of the survey respondents reported engaging in direct delivery of health services in public schools on an on- 
going basis. 



18 



What Works HI: Sdiool Health in Urban Communities 



Section I 



Urban Health Department Service Delivery in Schools 
Contracted vs Direct 



Contracted 



Direct 




School System 

^ Other/Alternative 
I Non-Public 
□ Public 



Figure 5. Comparison of Urban Health 

Departments Reported Health Services 
Delivery Arrangements with Schools 



Urban Health Departments and Assessment 

Most responding urban health departments assist schools with surveillance/ monitoring activities and/or needs 
assessment and service planning activities (Table 4). Less than one-fifth [18 percent (26)] reported having 
no relationship with public schools for needs assessment/services planning activities and 26 percent (37) said 
they had no relationship in surveillance or monitoring with public schools. Surveillance is usually an on-going 
activity regardless of type of school (Table 5). However, as Figure 6 shows, needs assessment is more likely 
to be on-going in public schools but on request in both non-public and alternative schools. 



19 



What Wwks ID: Sdiool Health in Uiban Communities 



Section I 



Percent Urban Heahh Department Reporting 
Involvenient in School Needs Assessment 



Other/Alternative 



Non-Public 



Public 




10 20 30 40 50 60 70 80 
Percent 



Level of Relationshq) 
on request Hj on-going 



Figure 6. Urban Health Department Level of 
Relationship with Schools on Needs 
Assessment/Planning Activities 



Table 4. 



Reported Relationships Between Urban Health Departments and Schools: 
Assessment Functions 



MONITORING AND ASSESSMENT 


Public 

■::Sch<)blS •■■'■■"■"■'" :'■■■■■■" 


Non-Public 
Schools 


Other/ 
AiternatJve Schools 


Surveillance and/or Monitoring 


(145) 


(145) 


(145) 


Relationship 


68% (98) 


57% (82) 


47% 


(68) 


No Relationship 


26% (37) 


29% (42) 


36% 


(52) 


Unknown 


7% (10) 


14% (21) 


17% 


(25) 


Needs Assessment/Planning for Services 


(145) 


(145) 


(145) 


Relationship 


77% (112) 


47% (68) 


49% 


(71) 


No Relationship 


18% ( 26) 


39% (56) 


35% 


(51) 


Unknown 


5% ( 7) 


14% (21) 


16% 


(23) 



( ) number of responses. 



20 



What Wwks EDI: School Health in Urban Communities 



Section I 



Table 5. Level of Urban Health Department Relationships with Schools for Assessment 

Activities* 



MONITORING AND ASSESSMENT 


Public 
Schools 


Non-Pubiic 
Schools 


Other/ 
Alternative Schools 


Surveillance and/or Monitoring 


(98) 


(82) 


(68) 


On-Going 


74% (72) 


61% (50) 


60% 


(41) 


On Request 


24% (24) 


39% (32) 


38% 


(27) 


Both 


2% ( 2) 


0% ( 0) 


0% 


(0) 


Needs Assessment/Planning for Services 


(112) 


(68) 


(71) 1 


On-Going 


50% (56) 


24% (16) 


27% 


(19) 


i On Request 


47% (53) 


76% (52) 


72% 


(51) 


Both 


3% ( 3) 


0% ( 0) 


1% 


( 1) 



* Urban health departments reporting a relationship (See Table 4) for monitoring and assessment activities. 

( ) number of responses. 



Urban Health Departments and Policy Development 

Ongoing relationships between urban health departments and schools around policy development is more 
common in the public sector (Figure 7). 



Percent Urban Health Department Reporting 
Involvement with School Policy Development 



Other/Alternative 



Non-Public 



Public 




10 20 30 40 50 60 70 80 
Percent 



Level of Relationship 
on request | on-going 



Figure 7. Urban Health Departments Level of 
Involvement with Schools on Policy 
Development Activities 



21 



What Works ID: Sdiool Health in Urban Communities 



Section I 



Many urban health departments indicated they usually work on request with the schools in their 
jurisdictions in developing policies and written guidelines (Table 7). 



Table 6. Reported Relationships Between Urban Health 
Policy Development 


Departments and Schools: 


jl|i|||i|||||i||B 1 : 


Public 
Schools 


Non-Public 
Schools 


Other/ 
Alternative Schocds 


Development of Policies/Written Guidelines 


(145) 


(145) 


(145) 


Relationship 


82% (119) 


59% (86) 


53% (76) 


No Relationship 


12% ( 18) 


28% (40) 


32% (47) 


Unknown 


6% ( 8) 


13% (19) 


15% (22) 



( ) number of responses. 



Table 7. Level of Urban Health Department Relationships with Schools for Policy 
Development Activities* 



POLICY DEVELOPMENT 



Public 
Schools 



Non-Public 
Schools 



Other/ 
Alternative Schools 



Development of PoliciesA/Vritten Guidelines 



11191 



(86) 



(76) 



On-Going 



44% 



(52) 



23% 



(20) 



22% 



(17) 



On Request 



55% (65) 



77% (66) 



78% (59) 



Both 



1% 



Ul 



0% ( 0) 



0% ( 0) 



* Urban health departments reporting a relationship (See Table 6) for policy development activities. 

( ) number of responses. 



22 



What Wofks m: Sdiool Heahfa in Utban Communities 



Section I 



Authority 

Is your health department's involvement with 

any of the schools or school districts located 

within its jurisdiction mandated by law and/or 

formalized through a written agreement? 

Health department involvement with schools is often based on legal statute or some type of formal 

document. Out of 145 responses, almost half [49 percent (71)] said their relationships with schools were 

either statutorily mandated and/or based on written agreements, memorandums of understanding (MOU), 

or contracts (Figure 8). Respondents were asked to briefly describe authority for their school 

relationships. Relationships based in state law often related to immunization, communicable disease, or 

food service sanitation. Several health departments indicated the relationship grew out of^ or was 

grounded in, a larger project or program such as Healthy Start, Community Integrated Services System 

(CISS), or the Robert Wood Johnson Foundation's "Opening Doors" initiative. 



Distribution of Formal Relationships 
Reported by Health Departments 



7.6% 



14.5% 




15.2% 



51.0% 



Instruments Used 
■ MOU ^ Law 

§ Contract []] Multiple 

[]]] Not Specified H No Formal 



Figure 8. Formality of Relationships Between 
Urban Health Departments and 
Schools in Jurisdiction 



23 



What Works ID: Sdiool Health in Uiban Communities 



Section I 



Eight health departments {italics. Table 8) mentioned more than one approach in the creation of formal 
structures for collaboration. 



Table 8. Health Departments Involvement with Schools Mandated by T^aw or Formalized 


Through Memorandum of Understanding (MOU) or Contract 


""^^^^^^ 


MemcMnanduin of 


Contract 


Not $pflcified 


i>:::i!i^ii^ii^-ii^ii!ii^(ii^^^^^^^^^^^^^^ 


Understanding 


(13) 


or Unsive 




(29) 




(9) 


Fairfield, CA 


Bakersfield, CA 


Los Angeles, CA 


Birmingham, AL 


Oakland, CA 


Berkeley, CA 


San Bernardino, CA 


Sacramento, CA 


San Bernardino, CA 


Long Beach, C A 


Savannah, GA 


San Diego, CA 


Santa Ana, CA 


Oakland, CA 


Topeka, KS 


Colorado Springs, CO 


Englewood, CO 


Salinas, CA 


Lexington, KY 


Wilmington, DE 


Lakewood, CO 


San Bernardino, CA 


Grand Rapids, MI 


Detroit, MI 


Waterbmy, CT* 


San Jose, CA* 


Kansas City, MO 


Rochester, NY 


Ft Lauderdale, FL 


Stockton, CA 


BiUings, MT 


Syracuse, NY 


Miami, FL 


Ventura, CA 


Paterson, NJ 


Charleston, WV 


St Petersburg, FL* 


Denver, CO 


Greensboro, NC* 




Macon, GA 


Lakewood CO 


Dayton, OH 




Honolulu, HI 


Boise, ID* 


Burlington, VT 




Wichita, KS 


Peoria, IL* 


Seatfle, WA 




Shreveport, LA 


Gary, IN 






Lansing, MI* 


New Orleans, LA 






Wesdand,MI* 


St Paul, MN 






Lincoln, NE 


Springfield, MO 






New York, NY 


Charlotte, NC 






Raleigh, NC 


Raleigh, NC 






Tulsa, OK 


Winston-Salem, NC 






Philadelphia, PA 


Portland, OR 






Pittsburgh, PA 


Erie, PA* 






Memphis, TN 


Memphis, TN 






Garland, TX 


Nashville, TN 






Salt Lake City, UT 


Austin, TX 






Burlington, VT 


Houston, TX 






Alexandria, VA 


Alexandria, VA 






Newport News, VA* 


Spokane, WA 






Spokane, WA 


Tacoma, WA* 







* Model document submitted with survey: contact information can be found in Appendix C. 
Italics indicates urban health departments using multiple approaches. 



24 



What Wofks III: SdKMl Heahh in Utban Communities 



Section I 



Involvement in Comprehensive School Health Programs 

What are the areas 

of comprehensive school health 

your health department 

is involved with? 

For a school health program to be truly comprehensive, it should 

incorporate eight key elements addressing a broad range of needs. 

Pages 1 1-12 set out brief descriptions for each of these elements. 

Comprehensive school health programs are important to the 

health of children of a// ages, from pre-school to high school and 

beyond. 

Urban health departments responding to the CityMatCH survey 
were asked to identify their involvement in each of the eight 
comprehensive school health components. Responses were 
stratified by three grade levels: elementary, middle, and high 
school.^ Examples of some of the most commonly reported 
activities in each area appear in Table 9. 



.^ 


Heahh Education 


^ 


Heath Services 


y" 


Community 
Involvement 


Z' 


Healthy School 
Environment 


^ 


Nutrition Services 


^ 


Physical Education 


/" 


Counseling and 
Psychological Services 


^ 


Health Promotion for 
Staff 



25 



What Wtxks ID: School Health in Uiban Ccmununities 



Section I 



Table 9. Percent (#) of Urban Health Departments Reporting 
School Health Programs by Component 


Involvement in Comprehensive 


i||||i|!!*^ntg^^^^^^^ 


Bamentary 


Middle 


High Schooii;:|||||| 


Health Education 


54% (78) 


59% 


(85) 


61% 


(89) 


Health Services 


66% (95) 


64% 


(93) 


66% 


(96) 


Counseling & Psychological Services 


32% (47) 


37% 


(53) 


44% 


(64) 


Community Involvement 


58% (84) 


55% 


(79) 


57% 


(82) 


Nutrition Services 


24% (35) 


24% 


(35) 


26% 


(38) 


Healthy School Environment 


35% (51) 


38% 


(55) 


39% 


(56) 


Physical Education 


12% (18) 


15% 


(22) 


13% 


(19) 


Health Promotion for Staff 


35% (51) 


33% 


(48) 


32% 


(47) 



( ) number of responses. Overall response of 145. 

The eight components of comprehensive school health programs were stratified by grade level and ranked 
according to the percentage of health departments indicating their involvement with each component. 
Responses to this question showed little variation in an urban health department's involvement in school 
health activities in relation to the grade level served for most program components (Figure 9). 



Urban Health Departments Reporting 
Involvenient with Health Services 



70 

60 

50 

2 40 

O 

§30 

fit 

20 

10 






Grade Level 
^ Elementary 
Q Middle 
Q High School 



Figure 9. Urban Health Department Involvement 
with Schools by Grade Level for 
Health Services 



26 



What Works III: School Health in Urban Ccmununities Sectiwi I 

Of the eight school health components, urban health departments are more likely involved in the areas of 
health services, health education, and community involvement. At least half of the responding urban 
health departments were involved in these three components across all grade levels. Figure 10 shows the 
distribution of involvement across components at the high school level. 



Health Department Involvement in Comprehensive 



« 
c 
o 

o. 

E 
o 
U 



High School} 

Physical Education - 

Nutrition Services - 


leal 


th Programs 






1 


UAolfh Prrtmr^tirvn frtr d-o'pr 


^^1 


■1 




1 




^ 




■■ 




Health School Environment 












^^ 




■1 


^a 








^^m 






Community Involvement - 






^^M 
^^1 


I 


I 


1 


Healdi Education - 










■^ 




Health Services - 






















1 



10 20 30 40 50 60 70 
Percent 



Figure 10. Distribution of Urban Health 

Department Involvement with Services 
Provided to High Schools 



Several health departments reported successful collaboration between schools, health departments, and 
other agencies to build integrated services. One-quarter to one-half of the urban health departments 
responding were involved in counseling and psychological services, health promotion for school staff, and 
healthy school environments. As seen in Figure 1 1, counseling and psychological services showed the 
greatest variation by grade level, with urban health departments more likely to be involved at higher grade 
levels. This may be a response to behaviors that are manifested at an older age. Urban health 
departments have responded by developing peer mediation programs, peer counseling, and staffing school 
based health centers with mental health counselors. 



27 



What Works III: School Heahh in Urban Communities 



Section I 



Percent Heahh Departments Reportmg Involvement 
wtth CounseUng & Psychological Services 




Grade Level 
^ Elementary 
^ Middle 
Q High School 



Figure 11. Mental Health Services Provided by 
Urban Health Departments by Grade 
Level 



Urban health departments are least likely to be involved with nutrition services and physical education, 
with less than one-quarter of the respondents indicating their involvement in these programs. Those who 
did report their involvement in nutrition services were frequently involved with inspection of food 
preparation areas and nutritional counseling through school based health centers. 



28 



What Works m: School Heahh in Ufban Communities Section I 

Urban Health Departments and School Health Centers 

Are there any school-based/school-linked 
health centers in your health department's jurisdiction? 
If so, how many and is your health department involved 
as the lead agency or in any other capacity? 

School health centers can be divided into two groups depending on their location and the number of 
schools they serve. School-based health centers are located on school grounds and serve only that school. 
School-linked health centers are located on a school campus but serve more than one school, or can be 
located ofiFthe school campus, regardless of the number of schools served.^'* 

School-Based Health Centers 

Fifty-five percent (79) of responding health departments in 36 states indicated that one or more SBHCs 
were located within their jurisdictions; a total of 334 SBHCs in all. Fifty-three percent (177) were 
located in high schools and 34 percent (1 14) in elementary schools. 

Only 17 percent (13) of health departments with SBHCs in their jurisdictions reported they had no 
involvement with any SBHCs. Seventy-two percent (57) reported they were involved with all the SBHCs 
in the jurisdiction, and of these 35 percent (20) indicated they were the lead agency for all SBHCs within 
their jurisdiction. 

School-Linked Health Centers 

Thirty percent (44) of responding urban health departments in 28 states indicated that one or more 
school-linked health centers were located within their jurisdictions; a total of 190 SLHCs in all. As with 
SBHCs the majority of SLHCs were located in high schools [55 percent (105)]; the fewest [20 percent 
(38)] were in middle schools. Thirty-nine percent (17) of health departments who had SLHCs in their 
jurisdictions said they had no involvement with any SLHCs. Another 43 percent (19) reported they were 
involved with all the SLHCs in the jurisdiction, and of these 58 percent (11) indicated they were the lead 
agency for all SLHCs within their jurisdiction. 



29 



What Woiks m: Sdiool Health in Uifoan C<mmiuiuties Section I 

A few jurisdictions, 18 percent (26) reported the existence of both SBHCs and SLHCs in their 
jurisdictions. Appendices D, £ and F, list each urban health department who reported having at least 
one SBHC or SLHC in its jurisdiction, the grade level (elementary, middle, or high school), and the 
degree of involvement of the health department. 

What types of services are provided by your 
health department in a school health center? 

The services most often provided by urban health departments in a SBHC or SLHC setting were 
identified as health education services [SBHC~72 percent (57), SLHC— 84 percent (37)] and medical 
services [SBHC~71 percent (56), SLHC~80 percent (35)]. Mental health and social services were 
provided by less than half of the responding health departments with school health centers in their 
jurisdiction. 

ENDNOTES 



1 . CltyMatCH membership is extended to all health departments having one or more cities within their 
jurisdiction with populations of 100,000 or greater according to the 1990 U.S. Census. Membership is 
also extended to the health department serving San Juan, Puerto Rico, a city of over 200,000. In states 
having no city of this size, membership is extended to the health department serving the largest city in the 
state. 

2. Institute of Medicine. The Future of Public Health. Washington, DC: National Academy Press (1988). 

3. It is recognized that the actual grades included in "elementary," "middle," and "high" schools vary 
between jurisdictions. For survey purposes no attempt was made to define these terms. Health 
departments self-selected based on their own definitions. They were not asked to identify what grade 
levels included. 

4. McKinney, D.H., Peak, G.L., School-Based and School-Linked Health Centers: Update 1993. The Center 
for Population Options (1994). 

5. These barriers roughly correspond with those identified in: Korber, N., Caring Schools, Caring 
Communities: an Urban Blueprint for Comprehensive School Health and Safety, Washington, DC: Council 
of Great City Schools (1993), based on a national invitational symposium on urban school reform, health 
arvJ safety. 

6. Integrating Education, Health and Human Services for Children, Youth and Families: Systems that are 
Community-Based and School-Linked, Washington, DC: American Academy of Pediatrics (1994 Final 
Report). 

7. Tyack D. Health and Social Services in Public Schools: Historical Perspectives. The Future of Children, 
Spring 1992; 2(1 ):1 9-31. 

8. Dryfoos JG. New Frontiers in School Health Services. Current Issues in Public Health 1 995; 1 :30-34. 

9. American Academy of Pediatrics, Task Force on Integrated School Health Services. Integrated School 
Health Services. Pediatrics 1994; 94(3):400-402. 

30 



What Works m: School Heahb in Ufban Communities Section I 

10. Riley RW and Shalaia DE: Joint Statement on School Health, 1993. 

1 1 . Association of State and Territorial Health Officials. ASTHO Survey of State PrimBry School Health 
Contacts, December 1994. 

12. Schlitt JJ, Rickett KD, Montgomery LL, Lear JG. State Initiatives to Support School-Based Health Centers: 
A National Survey. Journal of Adolescent Health 1995; 17:68-76. 

13. General Accounting Office. Health Care Reform: School Based Health Centers Can Promote Access to 
Care. GAO/HEHS-94-166, Washington, DC, 1994. 

14. McKinney DH. Op cit. See end note number 4. 

1 5. Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. 
School Health: Findings From Evaluated Programs, Washington, DC, 1993. 

16. Multnomah County Health Department. School Based Health Centers: Report on Services, 1992-1993. 

17. Urban health department activities have been profiled in the following CityMatCH publications: Peck MG 
and Hubbert. Improving Urban MCH Linkages: Highlights of the 1993 Urban Maternal and Child Health 
Leadership Conference, Peck MG, Bullerdiek HW, Rostermundt JE. Effective Leadership During Times of 
Transition: Highlights of the 1994 Urban Maternal and Child Health Leadership Conference, and The Road 
to Community Partnerships: Highlights of the 1995 Urban Maternal and Child Health Leadership 
Conference, in preparation. 

18. Making the Grade - The George Washington University. Medicaid, Managed Care, and School-Based 
Health Centers: Proceedings of a Meeting with Policy Makers and Providers. Washington, DC: June 26, 
1995. 

19. US Department of Commerce, Bureau of the Census, Census '90 Basics, Revised April 1993. 

20. Office of Disease Prevention arKl Health Promotion, Op cit. See endnote number 1 5. 

21. Association of State and Territorial Health Officials, Op cit. See endnote number 1 1. 

22. The principal focus of the CityMatCH school health survey was Kindergarten through high school (i.e., K- 
12). A limited attempt was made to identify the level of health department involvement with the eight 
elements of comprehensive school health services at the Pre-Kindergarten level, however, no information 
was collected about the post-high school years. 

23. It is recognized that school structures vary from jurisdiction to jurisdiction, and that boundaries for the 
four levels are somewhat blurred. We have chosen not to attempt more precise category definitions, 
preferring to focus on a broader population concept. 

24. McKinney, Op cit. See endnote number 4. 



31 



THE URBAN 

HEALTH DEPARTMENT 

SCHOOL CONNECTION: 



SECTION II 



BARRIERS 
EXPERIENCED 

IN 
SCHOOL 
HEALTH 



What Works III: School Health in Urban Ccmununities Section 11 

BARRIERS AND STRATEGIES 

What are the three greatest barriers 

your health department has experienced in trying 

to collaborate with the schools in your jurisdiction 

and how have you overcome them? 

Following is a review of barriers identified by responding urban health departments and their efforts to 
overcome or minimize their impact. Responses are grouped under the categories Attitude, Resources, 
Societal, and Systems barriers. These categories serve only as a general guide since many of the barriers 
cited include multiple characteristics whose weight in reality may differ fi-om that assigned by the authors. 
Strategies reported by urban health departments to overcome obstacles include the following: 

o Pursue both individual and group dialogue to clarify issues and build broad- based support for school 

health services. 

o Identify key individuals in the school system and health department to facilitate the coordination of 

services. 

Create and support structures to promote collaboration. 

While the various strategies to overcome barriers to collaboration described by responding urban health 
departments are generally consistent with recommended approaches for successful collaboration, they fall 
short of the principles to link by outlined in the consensus document Integrating Education, Health and 
Human Services for Children, Youth and Families. There were numerous examples were system needs 
reigned over family needs. Access to a comprehensive continuum of services is not possible when clinics 
close at the end of the school year or are available only to elementary grades. Communities need stable 
fimding sources that are flexible enough to meet their needs and promote intra-agency and interagency 
decision making. A number of health departments mentioned involvement in program planning and 
development, but less apparent was the use of needs assessment and evaluation as part of an ongoing process 
of service provision. Only one urban health department mentioned a language barrier; cultural competence 
was not raised as an issue. 



32 



What 'Works JD: SdKx>I Health in Urban Omimunities 



Section n 



Table 9. Barriers to Collaboration With Schools 

Encountered by Responding Urban Health Departments 



Perceived Barrier 


Total* 


" — 

Representative Efforts to Overcome 


Attitude 


21% (59) 




Jurisdiction/Turf 


20 


Encourage open dialogue 


Communication/Education/Knowledge 


16 


Establish shared time to build understanding 


Role Confusion 


9 


Ongoing clear communication of expectations 


Priority/Lack of Importance 


7 


Demonstrate value to school oflBcials 


Parental Involvement 


7 


Use multiple support structures 


Resources 


35% (101) 




Financial 


52 


Expand financing through businesses and grants 


Lack of Staff 


16 


Use volunteers, medical school residents 


General Support 


13 


Find new sources, redirect old 


Lack of Time 


11 


Negotiate for in-service time 


Lack of Space 


9 


Mobile vans, advocacy 


Societal 


15% (44) 




Sensitive Issues 


30 


Start with areas of common ground 


Administrative Fear 


8 


Build grass root support 


Service Restrictions 


6 


Create referral network 


Systems 


29% (82) 




Coordination 


20 


Key individuals provide oversight 


Bureaucracy: Rules/Regulations 


18 


Interagency agreements 


Communication 


13 


Direct contact, create forums 


Collaboration 


11 


Create structures to facihtate 


Planning 


10 


Increase community input in planning 


Service Provision 


5 


Use referral network 


Privacy Issues 


4 


Use consent forms 


Technology 


2 


Source out, ahgn policies 


Liability 


2 


Health department takes responsibiUty 



* Total number of responses citing this barrier, responding health department may have more than one response within a given 

barrier category. 



33 



What Works III: Sdwol Heahh in Urban Communities 



Section n 



Attitude 

Refers to individual and group values and understanding; common response strategies include the 
encouragement of open dialogue and demonstrating the value of comprehensive school health programs. 
Subcategories identified are: 1) Jurisdiction /Turf Issues, 2) Communication, Education and Knowledge, 3) 
Role confusion, 4) Priority /Lack of Importance, and 5) Parent Involvement /Community. 

1. Attitude Barrier - Jurisdiction/Turf 

Twenty urban health departments (UHDs) in fifteen states identified jurisdiction and turf issues as barriers 
to school health services. Concerns over "who is in control" was mentioned as often as coordination hurdles, 
ranking third overall behind fiscal limitations and sensitive issues. 



Perceived Barrier 


Efforts to Overcome 


Feeling of competition with^etween school nurses and 
public health department. 


Public health nurses collaborate with school nurses in 
identifying family/children problems. Nurses in school 
may go to home but refer to phone for ongoing case 
management. The school nurses have been utilized in 
connecting students who need to be followed for 
pregnancy, STD and TB. Threat of competition 
alleviated. 


Schools lack ownership of services provided. 


Use of parent volunteer or designated school staff to 
assist with scheduling clinic. Orientation of staff prior 
to clinic - flyers and promotion of clinic throughout by 
energetic school personnel. 


Perception that school-based health centers will cause 
dislocation of school nurses. 


Currently working with school nurses to 
resolve/identifying specific roles and responsibilities 
including school nurse in all planning activities related 
to school-based health centers. 


Lack of understanding of each others mission. 


The superintendent established an ad hoc task force in 
the 1993-94 school year to address school health issues, 
determine priorities and set mutual goals for the future, 
this set the stage for a new and improved working 
relationship. 


Turf guarding. 


We have encouraged open dialogue and communication 
with all stake holders (parents, school officials, health 
department personnel, other health care providers, etc.) 
The overall goal of providing school-based services is 
emphasized on a continual basis. 



34 



What Wofks ni: Sdiool Heattfa in Urban Communities 



Section n 



Attitude Barriers - Jurisdiction/Turf (continued) 


Perceived Barrier 


Illlllllllllll 


Public schools have own nurses. 


Staff for health matters (health ed and first aid) outside 
input is not welcome parochial schools and private 
schools have no health staff but want help of pubhc 
health nurses only for screenings required by state and 
outbreaks (ie. hce, shigella). 


Perception that health department is taking business 
away from MDs. 


Quarterly meeting with officers of local medical society 
to share common concerns, ie. access to care. 


School nurses see school-based health center as a threat. 


Numerous efforts to include, ie., built new clinic, 
offered ofiQce space, paired with other school nurses 
who have school-based health centers and included in 
planning. 


School department feeling they own nurses as far as 
assignments. 


Working with school department to recognize lines of 
authority and how they should contact our nurses to talk 
about changing hours or assignments. 


Reluctance of teachers/staff to refer students to health 
centers. 


School-based health center staff made special effort to 
encourage teachers/staff to visit the clinic. In addition, 
free flu shots and TB tine testing were offered to 
teachers and staff 


Turf issues. 


Open, honest, ongoing communication between 
partners. 


Territorial. 


Sometimes it is unclear what is school's responsibihty 
versus health department's. Have tried to improve 
ongoing communication on all levels. 


School is for learning - other programs take away from 
classroom time. 


In reference to school-based 2nd MMR clinics. Climes 
after school didn't get many students. School nurse then 
requested at school services they could assist. 


Turf issues. 


Until recently we could not even provide immunizations 
on school premises. Could at times do some health 
education/screening at schools out of city school district 
area. 


School health staff hired by educational service; rigid 
director: non-collaborative district approach. Turf. 


Health department health officer (MD) is their medical 
director; health department managers and staff continue 
to try innovative (contact) and cooperative approaches 
at individual schools levels. Frequent meetings and 
offering health department staff to serve on many 
planning and service deUvery efforts sponsored by 
various agencies. 



35 



What Works III: School Health in Urban Communities 



Section n 



Attitude Barriers - Jurisdiction/Turf (continued) 


iliiiiiiiiiiiiiiik 


IMqr1^:tQ,Q\;ta^ 


School districts have their own health programs. 


Extensive efforts have been made to provide technical 
assistance to health staff of local districts. Limited 
manpower at the health department precludes the actual 
provision of education classes; a train-the-trainer 
method has been used instead. 


School system provided own health services 
exclusively. 


Dialogue in past years to allow access to schools for 
service deUvery have been attempted. 


Turf issues between school hired nurses, health 
educators and health department counterparts. 


Planned joint staff meetings and intentional efforts to 
improve/increase communications; shared staff training. 


The school pubUc system already have nurses. 


Provide services (immunizations) upon request. 


Turf and bureaucracy/who is in control? 


Continue working together with outside and community 
based agencies. 

- Right people are together at the discussion table 

- Highest access to policy makers 



2. Attitude Barrier - Communication, Education, Knowledge 

Sixteen UHDs in fourteen states identified communication, education and knowledge issues as stumbling 
blocks in collaborating on school health services. This subcategory focuses on the building of commonalities 
between people (language, cultures, etc.). The communication subcategory found under Systems Barriers 
(Seepage 63) looks at the structures (non-people) that often impede coordination and collaboration. 



Perceived Barrier 


Efforts to Overcome 


Cultural differences - ie. Public Health versus 
Education. 


Committed efforts to develop a shared vision and 
transcend organizational differences. 


Hesitancy of school board to allow services in schools. 


Explanation of need for services and what specifically 
(sic) services will be. Patience in dealing with schools 
and initiating additional services, evaluations and 
explanations of programs. 


Building partnerships with schools. 


We continue to link schools to their closest Urban 
Health Center. The rapid turnover of superintendents 
makes building partnerships with schools hard. With 
Uttle help or support we continue the goal of the 
EPSDT program and continually trying to build 
collaborations. [ 



36 



What Woiks ED: School Health in Urban Communities 



Section n 



Attitude Barriers - Communication, Education, Knowledge (continued) 


Perceived Barrier 


Efforts to Overcome 


ScHne public schools do not communicate/cooperate 
with Pubhc Health Nurses. 


Meetings with principals/superintendents. 


Nursing staff's identification of "frequent flyer" 
students who do not need services but frequently feel 
they must see a nurse. 


Educate nursing staff that these problems need to be 
discussed with child and further assessments are needed 
to uncover actual problem. 


Poor relationship with prior health department 
administrator. 


Holding meetings with superintendent of schools and 
his administrators. Health department serving on school 
department advisory committee and they on ours. 
Addressing problems in a mutually agreeable manner. 


Failure of the school system to fully understand that 
health issues are a joint venture with the health 
department. 


Education Health Policy Committee with joint 
membership from both health and education to discuss 
health issues; membership includes the Commissioner 
of Health and area commissioners. Superintendent of 
Schools and area superintendents. Inclusion of health 
department staff in education generated initiative. 


Relationship of health department staff with school 
staff teaming. Value of health services in educational 
setting (differing philosophies). 


Teaming programs, in-services regarding 
collaborations, invite school staff to be part of school- 
based center programs. Involvement of school-based 
centers and school staff in planning program in-services 
for family. 


Lack of sharing of information. 


Limited or late sharing of information and lack of 
involvement in planning has caused difficulties for staff 
and students. Constant communication and reminders of 
goals to streamline and be flexible to improve service 
are undertaken. 


Resistance of school administration to enforce state 
immunization and health laws. 


School health nurses maintain knowledge of current 
health law and educate these administrators to health 
needs and laws and risks to health when these are not 
enforced. 


Language/cultural of PubUc Health versus Education. 


Common workshops problem solving. 


Developing a common understanding of comprehensive 
school health beyond the concept of treatment of ill and 
injured student. 


This issue has and will continue to be addressed through 
the partnership team. Key result areas and key result 
measures have helped to clarify expected activities and 
outcomes. 


School personnel. 


More networking to involve more and different 
individuals to overcome practice differences. 



37 



What Works III: SdK>ol Health in Urban Conununities 



Section n 



Attitude Barriers - Communication, Education, Knowledge (continued) 


::MMMw:My^ 


Efforts to Overcome;,,,,,,,,,,,,,.,:,,,,,;,,,, 


School system personnel do not have a good concept of 
Comprehensive School Health - they do not know what 
they do not know about school health. 


One-on-one meetings or informal small group meetings 
with administrators to discuss issues. Sharing pubUc 
information. Attempt to be proactive. Make use of crisis 
situations to catch attention of administrators and 
media; used as springboards for discussion of poUcy 
revisions/pohcy development to prevent fiiture crises. 


School system's lack of awareness of local health 
department's capabiUty to provide disease prevention 
and health promotion services. 


Through the city's active program of community 
policing and then community empowerment, the school 
system has learned of health department abihty and 
interest in student and employee health. 


Communication and acceptance of disparity in public 
health/school expectation of school nurse. 


Staff in-service and training. Moving toward team of 
resources available by phone. Involvement of individual 
RHN on site based committees. Articulation and 
demonstration of assurance role. 



3. Attitude Barrier - Role Confusion 

Nine UHDs in eight states identified role confusion as a barrier to school health services. 



Perceived Barriers 


Efforts to Overcome 


Fear of job security by school nurses and social 
workers. 


Team work to assure school staff that a role exists for 
both school support staff and outside agency staff. 


Individual schools not understanding roles and 
responsibilities of all involved. 


Explain various roles and responsibiUties to local 
school staff in addition to school administrative st^iff. 
Clarifications of roles as necessary or as problems arise. 


Who is responsible for financing health program - the 
school system or the health department. 


The health department leadership views the school 
program as a continuation of pubUc health. The local 
city government council view the school system as the 
money bags since they have a broad tax base. The 
health department keeps health as the issue. 


School staffs consent of Community Health Nurses role 
in school is different than actual role. 


Much education was and still is needed in trying to 
clarify the role of the Community Health Nurse in the 
schools. Several principals felt the nurse should 
shampoo heads after pediculous was found along with 
washing clothes and transporting child home. Meeting 
with health department staff helped but problems still 
arise. 



38 



What Woiks III: SdKK>l Health in Uiban Communities 



Section 



Attitude Barriers - Role Confusion (continued) 


WmmmmmX^M^^i^^^ Barrier : ; ■ 


Efforts to Overcome 


Resistance to change. Roles of both agencies have 
changed over the years and as this happens individuals 
also must change. 


We have provided joint meetings in-services training 
and commimication opportunities for all stafFto grow in 
this area. Through an exchange of information all 
agencies (health, education, social services) have 
improved communication and seem to better understand 
the entire picture. 


Limited health promotion through health education. 
Lack of understanding of expanded role of school nurse 
by school administration. 


The role of the school nurse has been limited in many 
respects and school nursing services are too tasked 
focus (injury/illness care). Our all baccalaureate 
prepared staff are highly quaUfled and enthusiastic - 
would like to participate more in health education 
planning and implementation. 


Lack of clear definition of role of school in assuring the 
health of children. 


School codes are old and lack relevance to the current 
environment. We will continue to work with schools, 
within the limits of our fiscal and human resources, to 
defme needs and faciUtate access for those who can 
address needs. 


School system's lack of awareness of local health 
department's capabihty to provide disease prevention 
and health promotion services. 


Through the city's active program of community 
poUcing and then community empowerment, the school 
system has learned of health departments abiUty and 
interest in student and employee health. 


Disparity in pubUc health school expectation of school 
nurse. 


Verbal and written conoumunication on changing role. 
Participation in school, community coalitions: kids first 
integration services committees at a middle and upper 
management level. 



39 



What Worics m: School Health in Uiban Communities Section II 

4. Attitude Barrier - Priority/Lack of Importance 

Urban health departments in seven cities in seven states cited low or conflicting priorities as barriers to school 
health services. 



Perceived BaiTier 


Efforts to Overcome 


Schools do not see healtfi issues as their responsibility 
or a prioritized issue. 


Department participates on school collaboration to 
enhance health access and services to students. 


Lack of support from school superintendent. 


Continue to educate, have support come from all areas 
of the community. School committee is in support but 
abdicates to the superintendent's position. 


Priorities. 


Some schools continue to feel that it is not the schools 
responsibility to meet the physical/emotional needs of 
students. We continue to try and demonstrate how 
schools, families and the community need to woric 
together to fidfill the needs. Healthy children learn 
better. 


Low priority of troubled school board. 


Attempting to build on positive relationships 
estabhshed through provision of some services and 
multi disciplinary community coalitions. 


School district under federal desegregation order with 
httle room for negotiation. Health not addressed in 
order, nor is it funded, so it does not get done. 


The District is currently providing school-based clinics 
in some high schools funded through a Medicaid/private 
foundation fimding stream with hope for expansion. 
The health department is attempting to partner in this 
process. 


Low priority of school program at the state level and 
buck passing between state health and Department of 
Education. 


The department continues to conduct yearly inspections 
of all schools, in spite of the fact that state only 
responds to complaints and requests for plan review. 
We provide on-site training and certification of food 
handlers. 


School comphances. 


Due to the scarce interest shown by school ofBcials, 
occasionally patients evaluated get lost. To overcome 
this, the out-reacher has to involve the school 
coordinator in the process of evaluation and 
management. Close contact with school ofiQcials has 
turned out to be a must. 



40 



What Wofks ID: Sdwol Heahh in Urban Communities 



Section n 



5. Attitude Barrier - Parent Involvement/Community 

Seven urban health departments in seven states cited a lack of parent and/or community involvement as 
barriers to school health services. 



iiiiiiiiiiiH^^^^^ 


£flbrts to Overcome 


Parental involvement. 


The Healthy Start effort has been characterized by a low 
level of support on the part of parents. Grant and 
foundation support for these programs should include 
stipends and/or incentives for parent involvement. 


Getting parents to come to the school for the child's 
exam. 


Appointment letter sent notifying date and time of 
physical and stressed importance of them being there; 
letter sent to all parents in the school explaining school 
based program and asking them to participate. 


Parental consent forms. 


Forms are sent home several times. If this does not 
achieve results, a hst is given to the principal to assist 
the nurse in receiving information and/or signature of 
parent. 


Target community apathy - health and parenting 
education lacking among community. 


Developing a coalition with community resources and 
juvenile court to offer programs in housing projects, 
etc... one has been started through the manager of a 
HUD project. 


Obtaining parental involvement in education programs. 


Classes, door-to-door canvassing, meetings, home 
visits, awards ceremonies, letters and phone calls. 


Parental compUance with immunizations required. 


Collaborative efforts with school medical dept, the 
health dept and community action groups to educate and 
provide immunizations on site and through special 
clinics. 


Community involvement/not in my backyard. 


Work with community based groups. 
Community/neighborhood leaders are invited and 
participate in the planning and implementation. 



41 



What Wtvks III: SdioolHeaMi in Urban Communities Section II 

Resources 

Refers to limitations of money, people, overall capacity, time, and space; common response strategies are 
working with the private sector and volunteers, use of mobile vans and redefining roles to allow for broader 
implementation of skilled personnel. 

1. Resource Barrier - Funding Related 

Finding the money to pay for school health services was the hurdle most often identified by urban health 
departments. Fifty-two urban health departments in thirty-two states presented fiinding strategies ranging 
fi-om foundation grants and local business support to legislation, wdth varying degrees of success. 



lililllH^^^^ ■ ; 


Efforts to Overcome 


Having less resources than needed to meet the needs. 


Continue to try and secure additional funding to expand 
services. 


Funding. 


Locate sources of ftmding such as federal grants, local 
civic clubs and businesses. 


Inadequate funding of activities needed for school- 
based clinic services. 


Networking educating elected officials, working closely 
with state officials to identify funding potential, 
working closely with school/local officials to identify 
fimding potentials. 


Insufficient staffing and fimds. 


Provide as much service as possible, particularly to 
areas without ready access to other sources of 
assistance; seek grant funding where appropriate. 


Lack of funding firom both the city and the school 
district. 


Seeking grants to assist in planning activities. The City 
schools have received two Healthy Start grants. 


Funding. 


The department has served on the local Healthy Start 
collaborative and supported the Healthy Start 
operational grant submitted to the state. 


Establish permanent funding streams for the 
Child/Hedth Demonstration Project. 


Operating the program on existing resources with 
MediCal reimbursement and Child/Health 
Demonstration Project revenue as primary funding 
sources for schools. 


Resource limitations and categorical funding. 


New funding and a visionary commitment to serving 
one and two prevention at the school catchment area 
level. 


Funding. 


More in-kind services, smoother referral and good 
hand-off. Increase use of volunteers in the community. 



42 



What Wwks ID: School Heahh in Urban C<nnmunities 



Section n 



Resource Barriers - Financial (continued) 


Peixeived Barrier 


Efforts to Overcome 


Funding. 


Use of state/federal funds. 


Funding issues. 


Discussion, coUaboration around specific needs - 
program is made on a site-specific or program-specific 
basis. 


InsufFicient resources for school districts. 


There are 27 school districts in county, encourage 
schools to look at health needs through the children's 
council. Regionalize needs in the community; develop a 
menu of services to be offered. 


Inadequate binding to support service in schools. 


Have searched for grant funding jointly with the schools 
or other alternative funds. 


Inadequate financial support for school-based health 
services. 


Development of agreements that allow for outstanding 
staff from multiple agencies to work at school sites. 


Inadequate fiinding to support service in schools. 


Have searched for grant funding jointly with the schools 
or other alternative fiinds. 


Sluggish financial management system. 


Established a contract with a 330 to eliminate 
difficulties associated with the local government's 
forms. 


Financial. 


Not enough fimding to adequately provide for health 
care services for students in our schools. Have tried to 
increase financial base by seeking out grants at local, 
state and regional levels, some limited success. Will 
continue to try and make community aware of health 
care concerns re: child in schools. 


Inadequate funding. 


Interagency agreement to pool resources: County 
School Board and County Health Department share 
coverage of schools. 


Funding to provide school based health services. 


We have sought funding from alternative sources such 
as the indigent care trust fund and explored joint 
funding of nursing positions with school systems. We 
also hope to generate some funds through 3rd party 
reimbursement (Medicaid) by providing health check 
services within die schools. 


Funding. 


Currently negotiating with school system to partially 
fund a nurse to provide services in alternative school. 


Categorical funding with different department priorities. 


Re-working at our interagency school health planning 
group to possibly redefine its role and responsibilities to 
assure more coordination/collaboration. 



43 



What Works ID: School Health in Urban Communities 



Section n 



Resource Barriers - Financial (continued) 


S::g::;ii::iSiliiiP^^^^^^^^^^ 


Efforts to Overcome 


Funding. 


Cooperative grants. 


Funding. 


Robert Wood Johnson Grant. 


Lack of adequate funds. 


Do not have enough nurses to service 86 schools; 
program being changed to become consultants. 


Who is responsible for financing health program - the 
school system or the health depai Lment. 


The health dept leadership views the school program as 
a continuation of public health. The local city 
government coimcil members view the school system as 
the money bags since they have a broad tax base. The 
health department keeps health as the issue. 


Financial support. 


No willingness to put the financial burden on the 
property tax payor fi-om either the city or school side. 
Continue to write grants, no luck yet. 


Financial (not enough dollars for programs and 
personnel). 


Attempts to develop innovative billing strategies to 
increase fimds available for school health. Increase 
recruitment of volunteers to assist in school health 
related activities. 


Lack of fimding to supply staff for collaboration. 


hivolve funded programs (EPSDT, WIC, etc.) at the 
school site, so the staff can provide services related to 
the fiinded program as well as provide services in non 
traditional ways. 


Minimal financial resources to address violence and 
other prevention services. 


Violence is pervasive in famihes from all school 
districts. Local health department obtained small state 
grant to sponsor violence prevention training for 
schools. Training to incorporate development of policy 
initiatives, physical plant design changes, and crisis in 
prevention teams. 


Adequate funding for teen health centers. 


Grant writing; utilization of other agencies to provide 
services; third party on site reimbursement. 


We do not have funding for such efforts. 


Three school health forums - poor participation by 
schools. Attempted partnerships - schools unwilling to 
put up any dollars. 


Budget constraints to increase nursing hours when 
needed. 


Flexibihty within the program to serve the priorities of 
each schools individual needs; gradually increasing time 
in schools when possible; limited some of the school 
nurse services we offer in schools unable to cover the 
cost. 



44 



What Works HI: School Health in Uiban Communities 



Section n 



Resource Barriers - Financial (continued) 


Percdhred Barrier 


Efforts to Overcome 


Financial. 


Sioce we don't have access to more funds or staff we 
have had to prioritiTS what we take on and what we give 
up. We have developed collaborative partnerships with 
private providers in one school and with the medical 
school in others. Reimbursement for services. 


Lack of funding to start school-based health center. 


Seeking funding through state, federal and private 
grants. 


Adequate binding. 


Lawsuit initiated to require DOH to provide mandated 
health service implementation to be completed over 5 
year period of the allow city to fund this effort over an 
extended period. 


Stable consistent funding. 


Researching other funding sources, such as contracting 
with district for special services and accessing Medicaid 
funds. Involving other providers, such as those in 
school-based centers. Funding for school health services 
is county tax dollars with 40% reimbursement through 
state aid. 


Reahty versus expectations, i.e. financial constraints. 


Seek innovative fimding, receive some school funding, 
continue reality check. 


Schools not available for use during non-school hours. 
Principals not willing to cover costs of utilities, security, 
etc. 


Through other community based organizations, have 
paid for use of neighborhood schools for health 
education, health fairs and immunization programs. 


Limited financial resources. 


Supported school levy which passed on the fourth try. 


Limitations of health department budget. 


Currently exploring bond issues. 


Commitment to health services. 


Looking at grants to help supplement funding available; 
serving on task/areas that looks at school health lending 
support and leadership to issues and principles 
identified. 


Financial constraints. 


Legislature lobbying efforts. 


Financial. 


Collaboration and negotiation with local govt and 
school officials offer funding; grant apphcations to 
various sources for special projects and a school based 
clinic. 


Cost-sharing for health activities. 


Discussions continue with documentation of services 
offered by health department, no cost to schools. 



45 



What Woiks ID: School Health in Urban Communities 



Section n 



Resource Barriers - Financial (continued) 


Perceived Barrier 


Efforts to Overcome 


Lack of funding for school-based center. 


The health depai Liuent is not able to provide services on 
a school campus. However, the districts have excellent 
school nurses and the director of nursing at our health 
department works with the school advisory boards. 
Schools must find their own funding and have not been 
able to do so. 


Lack of funds and buildings. 


A school health consortium is very active to faciUtate 
coordination and establishment of other school based 
health centers on an as needed basis using estabUshed 
criteria. 


Methods of funding. 


In our state, school money comes from local taxes 
generated by the independent school district and state 
fund. Municipal funds do not contribute to the school 
system's budget for any programs, hiring, etc. 


Limited funding for both health department and school 
district. 


The State Department of Health is working to support 
school-based and school-linked projects throughout the 
state. Grants are competitive and early submission is 
essential for consideration. Also, the health department 
has initiated discussions with the local school districts 
with the aim to apply or joint funding. 


Fiscal management. 


Since the state has to increase and lobby requests for 
additional money, the locals must work closely to 
articulate and define needs. Additional problem of 
providing 1.5 FTE project initially, budget cuts in other 
programs make it difficult to continue this support; 
working with state to remedy this. 


Lack of resources. 


Levy for health services in city, partnership with 
community agencies, Medicaid administration match. 


Funding for services at private schools. 


City budget cuts/spending caps caused service cutbacks. 
Private schools were encouraged to advocate for or fund 
these services themselves. Efforts were unsuccessful. 
As a result, vision and hearing screening, nursing visits 
on a regular basis and participation in multi disciplinary 
staffing were cut. 



46 



What Works m: S<^kx>1 Health in Urban Communities 



Section n 



2. Resource Barrier - Personnel 

Sixteen urban health departments in twelve states said limitations in skilled personnel and supporting stafif 
were barriers to meeting the needs of their school health clinics. 



Ferceived Barrier 


Efforts to Overcome 


Staffing. 


Contract with medical school to provide family practice 
and pediatric residents for school-based clinic coverage. 


Volunteers from the surrounding community 
neighborhoods. 


Work closely with school Parent Teacher Organization, 


FRWC coordinators, neighboriiood agencies and pubUc 
health nurse of area. 


Cut back in school nurses. 


Work with school nurses by assisting them to gain 
access to health care for students, accept phone referrals 
from remaining school nurses. 


Providing a sufficient number of DHS physician 
preceptors to manage nurse practitioners at school sites. 


Redirected "in-kind" physician time for school 
programs. 


Staffing. 


Delays in hiring staff have prevented a timely response 
to school districts request for service. Efforts continue 
to process personnel requests and assign staff as 
resources are available. 


Decrease in school nurses resulting in httle 
knowledge/attention of schools to health concerns. 


Offered schools a chance to participate in 
administrative claiming (medical) to boost their frmds 
which would cover health personnel such as nurses. 


Lack of st^fFto provide direct service. A lot of schools 
would like to have their own Ml time sick care clinic for 
school and community. 


Through community assessments we are helping them 
define and justify needs, help schools identify resources, 
support grant writing effort and "train the trainee." 


Lack of personnel - health department on a hiring 
freeze. 


Hiring temporary help to cover. However, it is difficult 
to hire nurse at die health department's salary - also, 
school system pays their nurses more. 


Schools dictate type of health service in their district - 
too few nurses for student needs. 


Participate again in community groups with schools to 
try and educate regarding student needs. 


Pubhc Health Nurses serve the schools as well as the 
community; Fifty-two schools, 29,000 students and 
only 20 public health nurses. 


Assistance from school department in hiring school 
nurses. 


Stress of school staff from other issues so they are less 
willing to address health issues. 


Provide needed services as identified by school staff 
where feasible. Provide Ustening ear, individual health 
assessments, and counseling staff. Pubhsh three one- 
page newsletters a year to provide school staff with up- 
to-date information on select health topics and services 
provided by health department. Advocate for issues. 



47 



What Woiks III: School Health in Urban Communities 



Section n 



Resource Barriers - T^ck of Staff (continued) 


Perceived Barrier 


Efforts to Overcome 


School personnel turnover. 


In order to overcome this, the out reacher has had to get 
acquainted with practically the whole school. This way 
when there is a newcomer there is no need to start over 
again. This has required a greater effort and more 
school visits on our part. 


Site does not provide diagnosis and treatment of minor 
and acute problems. 


Attempting to fund a nurse practitioner for the 
provision of these services. 


Staffing. 


Increase physician stafOng by one; develop nursing 
team to work with school. 


Lack of staff resources to meet all requests for services 
by school staff. 


The depaiUiient is evaluating its program activities to 
determine priorities for programming. 


Limited staffing hinders district school personnel 
involvement in areas outside of school district. 


Consciously trying to involve school district st;»ff in 
plaiming and development of grant proposals and 
program development to get their early buy-in. 



3. Resource Barrier - Overall Capacity/Other 

Barriers identified by urban health departments that appeared to be linked to a strategy of accessing additional 
or alternative resources are included in the table below. Urban health departments in thirteen cities in eight 
states discuss efforts to overcome transportation issues, language barriers and overall community support 
of school health services. 



iiiilliiH^ Barrier ^ ; 


Efforts to Overcome 


Limitation of services. 


Contract with Department of Mental Health and check 
for optometry services. 


EstabUsh programs utilizing existing resources. 


Redirected existing resources. 


Insufficient resources for school districts. 


There are 27 school districts in County. Encouraged 
schools to look at health needs through the Children's 
Council. Regionalize needs in the community, develop a 
menu of services to be offered. 


Limited resources. 


Empower school districts and private sector to 
supplement public health efforts. 



48 



What Works ID: School Health in Urban OMnmunhies 



Section n 



Resource Barriers - Overall Capacity/Other (continued) 


iilllilill^^^^^^^^^^ 


Efforts to Overcome 


Multiple requests for public health active participation 
in Healthy Start projects. 


The health department has reorganized and combined 
pubhc health, mental health, drugs/alcohol and health 
education and tried to designate that one health 
depai Iment representative can represent the wide range 
of disciplines. Reality has been that each discipline has 
finally sent representatives due to the importance of the 
Healthy Start effort. 


Increasing complex medically needy children requiring 
more in-depth health care services enrolled within the 
regular school settings. 


(New inclusion laws) County school system nursing 
staff are trying to assist in training and monitoring 
school staff who will be assuring responsibihty for 
these students working in conjunction with assigned 
County Public Health Unit school nurse. 


Language. 


Joint in-service for nursing staff to provide health 
services for Spanish speaking families; secured Spanish 
translated school health manuals. Provide health 
services in two areas of culture specific populations 
(Hispanic and Southeast Asian). 


Access/Transportation. 


Provided mobile van services to under served areas 
within the city and the county. School sites provided 
extended hours for immunizations every evening M-F 
until 7 p.m. Provided on-site Hep-B immunization 
clinics for school staff 


Transportation to teen centers by other school districts. 


Consortium services; expansion of clinic hours so one 
can visit early evening. 


No longer able to continue scoliosis screening. 


Convince Easter Seals or other community organization 
to conduct program. 


Commitment to health services. 


Looking at grants to help supplement $ available; 
serving on task/areas that looks at school health lending 
support and leadership to issues and principles 
identified. 


CriminaUty. 


Most of the schools are located in high-risk areas. In 
order to reach these students, activities have been 
planned as groups and mostly in dayhght hours. 
Activities are previously announced to community so 
residents know who vsiU be moving around. Providers 
selected fi^om well known organizations. 


No availability of transportation to SID climes. 


Teachers may bring the kids. 



49 



What Works III: Sdiool Health in Urban Communities 



Section n 



4. Resource Barrier - Lack of Time 

Not enough time in the day or school calendar. These are some of the limitations identified by nine urban 
health departments in five states as barriers to school health services. 



Perceived Barrier 


: :,::::::X::;g::::::::::x;:::j:^ tO ' OVCrCOme 


Lack of access to teacher in-service time. 


Experience has shown that schools often implement the 
Michigan model and other health care curriculum in 
fi-agmented manner. Local health department works 
with intermediate school district in providing training 
and back ground materials. Student assessment program 
is means for increasing access to in-service time as 
health education professional speaker. 


Time. 


Requests come in every semester fi-om various grades 
requesting talks on several topics. Scheduling staff time 
can sometimes be difficult. We try to coordinate with 
other agencies to make sure presentations are provided. 


Time constraints. The health department is a year-round 
service whereas the school system operates on a nine- 
month year. 


County Health Department has modified our Service 
Coordination Project to provide year-round services for 
kids we serve and schedule all hidividual Family 
Service Plans during times in which school staff are 
available. Communication has been open and efforts 
being made by school system to have year-round 
services. 


AvailabiUty of school curriculum and classroom time to 
add something new. Time and financial resources for 
teacher training. 


Health Department works with schools to assure that 
programs use teaching methods and styles congruent 
with current teaching theory for average age. Still need 
fimds to reimburse school for substitute time so 
teachers can be released fi-om classroom assignment. 


Staff time restrictions; scheduling school time for youth 
education sessions. 


Health educators target schools in census tracts with 
greatest need. Meetings held with principals and 
discussions with school district administrators. 


Staffing. 


Increase physician staffing by 1; developed nursing 
team to work with school. 


Students cannot take time out of class to attend well 
baby clinic. 


Only do immunizations, we cannot do health Usting. 


Time. 


Trying to make staff dedicated toward schools (i.e. 
added new positions; included in job descriptions). 


Limited school time. 


Focus on RN as consultant. Training of school 
personnel on health and health related issues, 
facilitation of resources into school. 



50 



What Wotksin:Sdiool Health in Urban Communities Section II 

5. Resource Barrier - Lack of Space 

Proper facilities providing adequate privacy and sanitation was mentioned by nine UHDs in six states as a 
barrier to school health services in their jurisdiction. 



Perceived Barrier 


Efforts to Overcome 


Schcx)ls built without clinic space. 


Mobile units ordered, expected in service by fall of 
1995. 


Space limitations. 


Use of mobile health van. 


Having adequate and confidential space and access to 
students. 


Developing method of understandings with schools 
providing in-services to staffs about needs of students 
and necessity for having students released from class. 
Continue to struggle with space issue. In most 
successful efforts schools have provided 
space/materials once we have estabUshed a relationship 
based on shared responsibility for the children/famiUes. 


Lack of space on school grounds. 


Flexible times and days to provide services most 
appropriately. Hope to purchase a mobile clinic van this 
year - will diminish space problem greatly. 


Space very limited and department of education priority 
is for their staff/problems. 


Continue to work vrith the department of education and 
other departments responsible for facihties to assure 
that there is joint planning for space. Develop 
memorandums of agreement as necessary. 


Space in the school environment. 


Nurse discusses vrith principal need for an area large 
enough to do medical exams and therefore, privacy is 
necessary. Hand washing facilities should be in the 
room or close to the area. If hand washing is not 
available, alcohol wipes are used. 


Lack of appropriate space, including desk, access to 
private phone and locked file, and access to toilet and 
sink. 


Advocate for appropriate space and resources 
reminding school administrators that we could extend 
our services with adequate support. Provide quarterly 
reports to principal regarding services provided to 
school by health department. 


Overcrowding of schools, lack of space for nurses to 
woric. 


Nurses must be flexible and creative as well as assertive 
to identify private areas in which to work with students. 


Lack of space in schools. 


The county is building more schools and re-zoning. The 
schools with the greatest need are the most heavily 
populated and all the classrooms are used; classroom 
space is first priority, not student health services. 



51 



What Works III: School Health in Ufban Communities 



Section n 



Societal 

Refers to individual and group beliefs; subcategories included community and/or parent responses to sensitive 
issues, administration wariness to community response, and outright service restrictions. Common response 
strategies were to start with areas everyone could agree on, dialogue and build grassroots support, and use 
a referral system. 

1. Societal Barrier - Sensitive Issues: Community/Parent 

Community concerns on issues such as family planning made this subcategory the second most reported 
barrier encountered by urban health departments. Thirty urban health departments in twenty states provided 
insights into how they are addressing this most difficult and emotional of topics. 



Perceived Barrier 


Efforts to Overcome 


Legislation for K-12 comprehensive school health 
education (Healthy Student Act). 


Barriers not overcome yet. Years have been devoted to 
working with legislators. The legislative climate is one 
of conservatism. Bills to mandate health education in 
the schools have been written but never passed. 


Misperception that school-based center's are birth 
control pill or condom mills targeting unsuspected 
youth. 


Position information campaigns, re: the benefits of 
school-based center (SBC) services. Networking with 
school and elected officials, re: benefits of SBC, sharing 
position success stories with supporters of SBCs. 
Pubhshing quarterly/annual data updates. Educating 
staff" in SBC on their role in decreasing reactionary 
response. 


The community opposes services that include family 
planning. 


There has been numerous pubUc meetings with the 
schools and various community factions that are 
adamantly opposed to specific family planning services 
and education, agreement and consensus on school 
based health services with follow-up referral was 
obtained. Education with special focus on abstinence 
was agreed upon. 


Parental fear of health services/education related to 
STDs, birth control and pregnancy. 


Information provided to school districts for individual 
adaptation; focusing school-based services at 
elementary level. 


Traditional resistance of schools to provide family 
planning services to adolescents. 


Discussion and collaboration on Uttle programs - some 
altematives considered such as mobile clinics or 
transportation to community climes. 



52 



What Works HI: School Health in Uifoan Communities 



Section n 



Societal Barriers - Sensitive Issues (continued) 


Perceived Barrier 


Efforts to Overcome 


Parental fear of school based clinic. 


Parent meeting to address fears, re: birth control being 
brought on campus. Memo of understanding developed 
to state specifically what would be provided. 


Conservative nature of community seeking health 
education. Health services seen as synonymous with sex 
and reproductive services. 


Explain broader view point. Working with coalitions 
witii ideas of fmding common ground, mobilizing all 
views to attempt to reach consensus. Serving on 
advisory board in communities. 


Organized poUtical opposition to school-based health 
centers (SBHCs) by small vocal group. 


PubUc relations efforts to correct mis-information 
regarding SBHC (distribution of condoms take away 
parental control) presentations to superintendents and 
local school boards development of informational 
brochure. 


Philosophy of sexuality education. 


Service on advisory committees and meetings between 
administration. Cooperative planning meetings within 
the community. Discussions with school board 
members, re: teenage pregnancy rates. 


Hesitancy of school board to allow services in schools. 


Explanation of need for services what specifically 
services will be; patience in dealing with schools and 
initiating additional services; evaluations and 
explanations of programs. 


Community concern that school-based services will 
provide contraceptives to students. 


We have attempted to educate the pubUc about the type 
of services that are provided. 


Perception that health department dispenses 
contraception. 


No single effort; one-to-one clarification of facts. 


Great concern in districts that health agency will hand 
out birth control. 


Have refocused efforts to grade school levels where 
birth control not an issue. 


Community perception of school-linked clinic. 


Public forums, developed advisory board, clear poUcy 
statements, open door to community to visit clinic. 


A conservative philosophy of sex education and AIDS 
prevention. 


The health department has received a state grant for a 
pilot program of postponing sexual involvement and 
reduced risk; school system approved. 


Parents feared school-based health center would force 
birth control on students. 


Forum held with groups to try to overcome problems 
with sex education and birth control issues. No 
consensus was ever reached. 


Pro-life faction. 


Educate, Educate, Educate. 



53 



What Works III: SdKwI Health in Uihan Communities 



Section n 



Societal Barriers - Sensitive Issues (continued) 


Perceived Barrier ,:,,.,,,,::,,,,,,,,,i:,,,;,.,^ 


EfTorts to Overcome 


Community's negative attitude toward school-based 
clinics. 


Educate public to value of school-based services; 
demonstrate worth of school-based centers beyond 
services provided for family planning. 


Acceptance of sexuality needs of student. 


Provide resource materials and speakers for human 
growth and development classes; participate in 
curriculum development as allowed. Provide parent 
sessions to view materials. Develop trusting 
relationship with school staff Write newspaper articles 
on comprehensive sexuahty education in response to 
letter. 


Politics. 


Influence at the Christian Right. Continued respectftd 
negotiation between Boards of Health and Education. 


Community fears about the services we provide, i.e. 
Sexuality, pregnancy prevention. 


We try to include school, community, parents, students 
and staff in surveys to ascertain desire of the 
community. We have parent advisory group in each 
school. We do not limit ourselves to controversial 
programs but offer broad based services. 


Parent teacher association is dominated by a group of 
parents who adamantly oppose any and all health 
education in the schools and any health services being 
provided in the schools. 


Respond to requests by students for class presentations 
on STD, family planning and HTV/AIDS; provide injuiy 
prevention safety promotion presentations on requests; 
provide information in-services to school nurses. 


Health services identified as "sex services" giving birth 
control. 


Continuing education to community; working with 
groups and providing limited health service to help 
open up other more extensive service opportunities; 
joining together with other groups with same interests 
to gain broader base of support. 


Conservative community. 


Pubhc school is "off base" for some areas of health 
education and services, i.e. Family life education 
increased teen pregnancy rate in state. Very difficult to 
overcome influential people in community against 
many programs. 


Ultra conservatives (politically) and fundamentalists 
(religious). 


Unable to discuss in a forum the needs to educate 
children as regards social mores and sexual practices 
leading to infections and subsequent secondary. 


Rehgious opposition to public health role in family 
planning. 


Concentrate on elementary or less aged child. 


Conservative groups opposition to school health 
initiatives. 


Community involvement in planning and 
implementation; constituency building. 



54 



What Wmks ID: SdKwI Healtfa in Uiban Communities 



Section 



2. Societal Barrier - Administrative Fear 

While this subcategory could easily be folded into the Sensitive Issues: Community/Parent table (above), 
eight urban health departments in seven states appeared to focus more on the school districts reluctance to 
address certain issues. Four health departments used a community-based approach to "open the door." 
Community partners, such as Parent Teacher Associations, can be an effective way to lower administrative 
resistance. Limitation of services to elementary grades and limiting the curricula content were other 
s^proaches mentioned. 



Perceived Barrier 


Efforts to Overcome 


Elected boards fearfiil of conservative parent outrage 
over sex related activities. 


Health department initiated programs only in 
Elementary Schools. Middle School services are now 
only being discussed. High School is still taboo. Health 
department also has taken strong sexual abstinence 
position in pubhc discussion. 


Many districts want to avoid many topics. 


Action by coalitions to educate district patrons and 
board regarding health issues through media, meetings, 
etc. Seek common areas which are acceptable by/to all 
districts as a starting point. 


Reluctance to address sensitive topics and services 
related to sexuaUty and reproduction. 


County Health Department collaborating with pubhc 
schools to pilot two human sexuality curricula in 
classroom settings. A more comprehensive parenting 
and family life skills curriculum available to be taught, 
but never adopted. County sued in 1991 by parents for 
sex education. 


Administrations fear of pubUc reactions to some topics 
such as pregnancy prevention. 


Exposure of local problems and co-author content with 
school before presentation - efforts to involve parents 
with a pre-presentation meeting of which programs is 
pre-viewed and presenter is available for questions. 


Reluctance to incorporate messages related to sex 
education. 


Education projects such as HTV/AIDS/STD 
communicate with schools in panning to insure 
^propriate content within schools comfort boundaries. 


Conservative school board numbers. 


The main concern is family planning issues in the 
adolescent population; currently Reno has 2 school- 
linked health clinics in both family resource centers. 
The plan is to start slowly at the elementary level and 
expand services in the fiiture. 



55 



What Works m: Sdiool Health in Urban Communities 



Section n 



Societal Barriers - Administrative Fear (continued) 


Perceived Barrier 


Efforts to Overcome 


Hesitancy of school administration to allow health 
department to present sensitive and perhaps 
controversial issues, e.g. family life education. 


Since the major concern was parental objection, we 
worked with the PTA, educating them to the value of 
the information, program and services, and then had the 
PTA approach the school administration with their 
request. 


Reluctance of schools to allow/provide preconceptual 
health information to students to market teen health care 
services. 


Working with Better Beginnings Coalition and the 
school medical depai Unent to provide information to 
teens off-site. The health department has recently 
received permission to post information (general) 
regarding teen services in middle and high schools. 



56 



What Wofks ID: Sdtool Health in Urban Communities Section n 

3. Societal Barrier - Services Restricted 

Six urban health departments in four states described specific barriers to the delivery of school health services. 



Perceived Barrier 


Eflbrts to Overcome 


Teen pregnancy prevention allowed on campus. 


Work within the collaborative and provide other 
assistance. Governing boards are more willing to add 
service. Provide services off campus but in close 
proximity to school offer services to whole family and 
extended family if non-students receive/request services 
(family members). 


Providing pregnancy prevention information, birth 
control, condoms. 


This is an issue we have yet to overcome. Each of our 
33 school districts prohibits the dispensing of 
information or suppUes. We will be addressing this 
issue in the Maternal Child Health Strategic Plan. 


Unable to fully promote family planning. 


Refer children to other clinics and compliance rate is 
poor. Provide counseling to fullest extent. 


Family planning advice not allowed in schools. 


Make family planning available after hours at health 
department. 


Provide presentations on sensitive subjects such as sex 
education. 


Each case worker must take and pass an extensive 
workshop provided by the school district to be certified 
to teach and present subjects on human growth and 
development. 


Extremely conservative views regarding school health. 


School nurses are restricted to traditional roles of 
screening (vision/hearing) etc... School-based and 
school-linked clinics have not been supported by 
parents in general due to fears of mass condom 
distribution. 



57 



What Wofks IH: School Health in Uri>an Communities 



Section n 



Systems 

Refers to limitations in structures, vehicles, process and procedures; subcategories included coordination 
issues, bureaucracy and regulations, communication channels, collaboration, planning efiforts, service 
provision, privacy issues, technology and liability. Common response strategies were: 1) ensure that key 
individuals have been identified, buy into the effort, and provide oversight; 2) use interagency agreements; 
3) use a lot of face-to-face contact; 4) use community forums; 5) create new structures to facilitate school 
based health care; and 6) use broad based community input in planning. 

1. Systems Barrier - Coordination 

Concerns around coordination of school health services was the third most reported barrier behind financial 
restrictions and sensitive issues. Twenty urban health departments in eleven states provided barriers ranging 
fi-om shear size of jurisdiction to number of schools to decentralized management systems. Different fiinding 
streams required different reports. Coordination difficulties were not limited to the health department-school 
dichotomy, but occurred inside health departments as well. 



Perceived Barrier 


, Eflbrts to Overcome:,:,.:,,,;.:,..^ 


Each school district is autonomous; there are over 200 
in the state. 


Each agreement/program must be developed 
independently: 1) Development of coalitions to support 
appropriate legislation, 2) Development of 
pubUc/private partnerships to provide information and 
education to school boards and state legislators, and 3) 
Provision of quaUty services when schools request help. 


Parental consent. 


School develops consent form with Parent Teacher 
Organization and primary care providers (not the health 
deparlment in this case). 


The large school systems often do not coordinate 
program efforts. 


It is often more effective to work directly with the 
principals to get things accomphshed. 


Sometimes a lack of coordination among the health 
deparlment divisions which are working with the 
schools. 


We now have a team vrith representation of all divisions 
having interaction with area schools. Their goal is to 
improve service coordination. 


Coordination. 


Collaboration and coordination of efforts involves a lot 
of time. The school district had to hire a fiill-time staff 
member to pull the effort together. Collaboration cannot 
be successful if it is dependent upon voluntary efforts to 
persons who have full-time jobs in their agencies. 



58 



What Worics HI: Sdwol Heahh in Urban Communities 



Section n 



Systems Barriers - Coordination (continued) 


Perceived Barrier 


Efforts to Overcome 


Each Healthy Start school managed differently. 


Healthy Start collaborative meetings held quarterly; 
meeting this quarter focused on suggestions to 
streamline referral and services in individual method of 
understandings. More central control without stifling 
creative approaches with each school. 


DupUcation of services. 


Identify service level and need - work collaboratively - 
planning and special projects targeting specific 
communities for blended funding. 


28 autonomous school districts. 


Work closely with local dept of education. Unify 
strategies through a county board of supervisors created 
children services coordinating committee. 


The high number of school districts means that ventures 
with the health department must be revisited, reviewed, 
etc... by each individual district before permission is 
received to collaborate. 


We have specified high-need schools and concentrated 
our efforts with them. 


Decentralization of authority. 


As County is extremely large school district, principals 
have autonomy to set individual school priorities. 
Efforts to gain mutual agreement on basic pohcies and 
procedures, especially for immunization records and 
emergency situations. 


Logistics (lack of coordination by management on both 
teams). 


Working in separate facilities and rarely sharing 
common planning time was a true barrier. This has been 
overcome by the superintendent's willingness to provide 
office space in the school board building for the County 
Public Health Unit, school health coordinator and four 
additional health department staff. 


Enormity and complexity of County. 


Several times a year the school health coordinator 
speaks to all school registrants. This year plans are in 
place to do the same for school counselors and social 
workers. 


Coordination of services at times. 


The health department, in its contract with the school 
system, has delegated on position as the supervisor or 
coordinator of health services which dovetails with 
mandated State Board of Education requirement that 
local school district is to have a health coordinator. 



59 



What Wofks III: School Health in UiiMui Communities 



Section n 



Systems Barriers - Coordination (continued) 


Perceived Barrier 


Efforts to Overcome 


Coordination of health education/ promotional 
activities. 


Overcoming barrier required seeking out/working with 
local area school officials and working with local parent 
groups and community organs. All activities of the 
health centers involved participation from one or more 
of the above groups. 


Lack of coordination between the schools and mental 
health substance abuse services. 


In fall of 1990, local health department developed a 
central assessment unit and began providing student 
assistance program services to participating school 
districts. Local health depailment serves as primary 
point of intake for student assistance screenings and 
substance abuse assess with subsequent referral to 
appropriate treatment agency. 


Cooperation/coordination of joint efforts. 


Cooperation and coordination on several joint efforts, 
ie. Measles outbreaks/ immunizations. TB screening 
with the schools has been challenging from a financial 
and systems perspective. Continuing to work together 
has been helpfiil and flexibility is always necessary. 


Service dehvery in schools is chaotic: School-based 
centers - state fimded; school-based centers - city 
funded; Board of Education has to provide for 
mandated reporting of service; Department of Health 
has some mandated service. 


Currently city department of health is meeting with 
State Deparlnient of Health to standardize the school- 
based centers interaction with city which provides 
pubUc health case management services. City 
Department of Health and city Board of Education meet 
regularly to collaborate on assessment strategy. 


Size - 57 individual school principals, 26 pubUc health 
nurses. 


Consistent ongoing training and education by both 
agencies to keep their staff informed of policies, 
procedures and areas of responsibihty. 


Lack of coordinated integrated child focused family 
centered community based services. 


Mayor estabhshed a Mayor's Children and Families 
Cabinet which includes all city operating departments 
and the city school district to provide coordinated 
integrated child and family centered community based 
services. 


Duplication of services. 


Program and school administration are working on a Ust 
that will detail all the health services that the school 
district, as well as other agencies, provides to the 
students and their famiUes. 



60 



What Works ID: SdKwl Health in Urban Communities 



Section n 



2. Systems Barrier - Bureaucracy: Rules/Regulations 

Bureaucracy was encountered by eighteen UHDs in fourteen states, making it the fifth most reported barrier 
to collaboration in school health services. One health department's poignant response best summarized the 
efforts of all: "Persistence, tenacity, diplomacy. " 



Perceived Barrier 


Efforts to Overcome 


Public Health and schools are fiinded through separate 
restricted pools of revenue. 


State level memorandum of understanding have been 
drafted but fiill jointiy fimded operations are difficult. 


Bureaucratic barriers. 


Continuous collaboration and communication within a 
common goal to serve children and families. 


Bureaucracy between agencies. 


Each agency is part of a veiy large bureaucracy. The 
interagency agreement has helped, however, with some 
schools being covered by district school system and 
some by the health department, there are differences 
between their approach; joint meetings are held. 


Bureaucracy. 


Work with local community group - project attention 
which offers social services to schools in that setting. 


Poor salaries to keep staff to provide continuity. 


Working on improving salaries through civil service. 


Two separate governing bodies for school nurses. 


School nurses are employed locally by each school 
district based on fiinding. They have no medical 
protocols or supervision by medical staff which unites 
their activities. School nurses were resistant to 
invitation to become pubhc health nurse because they 
fear they would lose their summers off. 


School District under Fed desegregation order, Uttle 
room for negotiation. Health not addressed in order, 
nor is it fimded, so it doesn't get done. 


The District is currently providing school-based climes 
in some high schools fimded through a Medicaid/private 
foundation fimding stream with hope for expansion. 
The health department is attempting to be a partner in 
this process. 


Pohcy differences. 


The County Health Department has participated in 
planning activities since 1989 when a public health 
nurse was fu-st assigned to the team by Chief of Pubhc 
Health Nursing; also signed a Statement of Agreement 
with the Public Schools and Department of Social 
Services to collaboratively work together to provide 
service coordination for children 0-3. 



61 



What Wotks III: Sdiool Health in Urban Communities 



Section n 



Systems Barriers - Bureaucracy: Rules/Regulations (continued) 


Perceived Barrier 


Efforts to Overcome 


Confusion over State regulations - Department of 
Education versus Department of Health. 


Consulted with regional office state education and 
health depaiUuent representatives for clarification (re: 
assisting with development of school based clinics by 
the school district). 


School nurses cannot provide health/prevention 
services, e.g. immunizations. 


Many children, especially 7th graders excluded d/t 
(inadequate immunizations). Now health department 
nurses go to middle school and give immunizations 
while school nurses assist with consents and other 
paperwork. 


School and health are two different and complex 
systems. 


Contracts/agreements needed to be detailed and each 
party's expectations and responsibilities reviewed 
annually. 


Law statutes. 


Collaboration with school districts as of 1994 law 
changed and we can now provide some services on 
school premises. 


Organizational and fimding requirements which 
preclude optimal service delivery. 


Recommendations to consolidate all health, educational 
and social services fimding streams (prenatal) into non- 
profit authority to be created through agreement among 
school district. Department of Health and Department 
of Human Services. 


Government mandates for school systems (especially 
for CHSN) which are "sent down" without fimding 
and/or are promulgated by those with inadequate 
understanding of health care in school settings. 


Hardest to address - raising level of public awareness. 
Efforts to increase number of school nurses so schools 
have resources to address needs of these kids. 


Bureaucratic hurdles of collaboration between agencies. 


Persistence, tenacity, diplomacy. 


School district bureaucracy. 


Making local school districts aware of the barriers some 
of their systems/policies pose and working with them to 
minimize those barriers, meeting more regularly with 
top school district administrators on a variety of issues. 


Turf and bureaucracy/who's in control? 


Continue working together with outside and community 
based agencies. - Right people are together at the 
discussion table - Highest access to pohcy makers. 


School mandates and educational model have a different 
focus from public health model. 


Example: Until fully oriented, school nurses focus on 
meeting minimum immunization requirements rather 
than the optimal levels, while working on a 
collaborative immunization project. 



62 



What Works III: School Health in Urban Communities 



Section n 



3. Systems Barrier - Communication 

Thirteen UHDs in thirteen states identified the physical process of communication as a stumbling block to 
providing school health services. This subcategory focuses on the structures (non-people) that often impede 
coordination and collaboration. The communication/education/knowledge subcategory found under Attitude 
Barriers (Seepage 36) looks at the building of commonalities between people (language, cultures, etc.). 



Perceived Barrier 


EfTorts to Overcome 


Presently the schools do not have their services Usted in 
a way that other schools or the community can be aware 
of the activities occurring. 


We have formed a youth coalition and part of the vision 
is to automate activities in all the Berkeley schools and 
the recreational activities offered by the city. 


Communication. 


EstabUshed an interdepartmental committee that meets 
regularly; school nurses invited to sit on student 
assistance teams. 


Poor communication between agencies involved in 
school-based health center. 


Establishment of advisory committee. Composition of 
same will be community residents, parents of students 
enrolled in center, students, school staff and community 
organizations. 


Some pubUc schools do not communicate/cooperate 
with PubUc Health Nurses. 


Meeting with principals/superintendent. 


Inadequate use of services (Adolescent Wellness 
Program, Committee Youth Program). 


Work with student support team to identify needs of 
students and inform faculty and staff of resources. 


Commimication to principal, faculty and parents. 


Attend faculty meetings and PTA meetings. 


Effective communication between local school district, 
local health department, state education, state health. 


A school health partnership team has been in existence 
for almost one year specifically to address neutral areas 
of concern between district staff and health department 
staff. Team consists of members from all levels of 
personnel. A joint vision, mission & strategic plan have 
been developed. Gains have been made. 


Commimication. 


We have identified one person with the health 
department and one with the school system to address 
and route all information related to school health; this is 
woridng well. 


Communication between school administration and 
school nurses. 


We make the effort to communicate with the nurses 
individually in order to ensure that they receive correct 
information. 



63 



What Works m: School Health in UrtMn Communities 



Section n 



Systems Barriers - Communication (continued) 


Perceived Barrier 


Efforts to Overcome 


Public lack of knowledge about comprehensive school 
health, failure to communicate between agencies about 
subject areas that cross agency lines, failure to 
comprehend impact of CHSN on schools. 


Written communication copies to all apprc^riate parties 
in all agencies. Raising questions which require 
interagency communication. Attempt to involve high 
level administrators. Participation in interagency task 
forces to work on problems. Facilitate grass roots 
involvement by parents and teachers. 


Communication. 


Schools want on-site acute care. Our health district 
provides preventive education and care. We 
standardized our outreach program to schools, set up 
meeting of multiple levels with the school district 
(superintendent, school nurse) to explore services. 


Communication. 


Formation of local interagency councils which include 
representatives at the local level from health, school 
districts, human services and juvenile justice; regular 
meetings are held to assist referred families and make 
pohcy. 


Non-public school, enter only by request. 


Describe services and available ourselves if needed. 



4. Systems Barrier - Collaboration 

Whereas cooperation and coordination can be used interchangeably when discussing system interactions, the 
term collaboration refers to a higher plateau of intra-agency and interagency effort. Collaboration requires 
a joint investment in such infrastructure as technological applications and information systems, facilities and 
equipment, training, technical assistance and administrative support. Eleven UHDs in eleven states describe 
efiforts to build collaborative structures to support school health services. 



Perceived Barrier 


Efforts to Overcome 


Difficulty developing collaborative teams in school- 
based health centers. 


Teamwork and development of formal poUcy and 
procedure manual for use in informing new staff of 
general expectations. 


Funding streams. 


Federal and state departments do not require 
coordination of agencies administering the same type of 
programs, i.e. AIDS prevention and counseling. We are 
currently attempting to set up joint committees. 



64 



What Works ID: Sdiool Health in Urban Communities 



Section n 



Systems Barriers - Collaboration (continued) 


Perceived Barrier 


Efforts to Overcome 


Two large bureaucracies translating plans to actions. 


Pre-planning for emergency situations: measles, 
meningitis outbreak; regularly scheduled meetings with 
environmental staff and school nursing staff. 


Independent solutions development to common 
problems. 


Need more communication to assure maximization of 
resources, prevent gaps and dupUcate efforts. More 
collaborative decision making, establish new 
memorandums of agreements where necessary. 


Building partnerships with Pubhc Schools. 


We continue to link schools to their closest Urban 
Health Center. The rapid turnover of superintendents in 
schools makes building partnerships hard. With little 
help or support we continue the goal of the EPSDT 
program. We are also continually trying to build 
collaborations. 


Pubhc health nurses are unionized with Teamsters 
organization. 


Woric with imion in helping/trying to institute changes. 


School nurses are employees of the school districts. 


Network constantly with individual school nurses and 
their administration; offer information/training 
regarding communicable diseases, community 
resources, etc. 


Woridng with three school systems in county. 


Resolved by merger of systems to one previous to 
merger health department meeting monthly with 
administrative representatives to resolve difference 
related to policies and procedures of three systems. 


Competition for dollars and services. 


Partnership building to spread scarce resources more 
effectively, more intensive efforts at integration and 
collaboration. 


No history of collaboration widi ensuing trust and open 
communication. 


Participation on committees concerned with school 
health issues, providing consultation on health 
problems, interpretating role of the dept, offering 
services where gaps exist and resources permit. There is 
a need for more collaboration between health and 
education at federal, state, and local levels. 


Barriers to ongoing and significant collaboration 
between public school and public health in a variety of 
programs/areas due to: insufficient time and staffing to 
allow collaboration. 


Ongoing; school mandates and educational model have 
a different focus from public health model, (example: 
until fully oriented, school nurses focused on meeting 
minimum immunization requirements rather than 
optimum levels while working on a collaborative 
immimization project). 



65 



What Wofks III: School Health in Uihan Communities 



SectioDlI 



5. Systems Barrier - Planning/Administration 

Ten urban health departments in nine states perceived problems in the planning process as a barrier to 
collaboration in school health services. 



Perceived Barrier 


Efforts to Overcome 


Short-term focus for long-term goals. 


Self-education regarding normative goal setting and 
incremental problem solving. 


School boards. 


Develop ongoing relationships with schools and school 
districts so that there is a full understanding of the role 
of public health in the commimity; provide programs 
through teachers rather than administrations. 


Categorical funding with different department priorities. 


Re-working at our interagency schools health planning 
group to possibly redefine its role and responsibilities to 
assure more coordination and collaboration. 


Determining scope of services. 


Involving students, parents, faculty and administration 
in determining scope of services. 


Mutual health planning. 


Works with support staff to identify areas of mutual 
concern i.e. immunization access to schools from 
clinical services use of school nurse. 


Managed care is creating a new maze for identifying 
and referring children to appropriate source of care. 


School-based centers and city DOH are meeting to help 
direct the recommendations regarding reimbursement 
managed care referrals and quahty assurance of care. 


Equitable division of school health responsibihties. 


Continue to participate in school health strategic 
planning forums. 


Non-consistent service boimdaries for health and social 
services. 


County formed geographic planning/service teams and 
invited others with similar boundaries to join in. County 
executive working with mayor and school district 
officials regarding charges in service districts. 


Need for community driven network of services. 


School district has convened a planning process to 
change its organization to 22 neighborhood clusters. 
The Department of PubUc Health is an active 
participant to assure availabihty and accessibihty of 
physical and mental health services. 


Formation of a plan to target schools that are most at 
risk. 


Program is woricing with school and administration and 
other health agencies that will form a forum to provide 
and review statistical information on each school 
concerning health and social issues to assess wiiere each 
school has most of its needs. 



66 



What Works III: Sdiool Healtfa in Utban Communities 



Section n 



6. Systems Barrier - Service Provision 

Five urban health departments in five states identified specific service level obstacles in the dehvery of school 
health services. Their efforts reflect changes in direct service delivery. 



Perceived Barrier 


Efforts to Overcome 


Child actually present at school on the day the exam is 
scheduled. 


1) Appointment letter sent to parent notifying of day 
and time, and 2) Try to find out school activities prior 
to scheduling to see if child will be there. 


Obtaining approval fi^om the School Board to provide 
services. 


Initially, flyers were placed in school advertising 
sources, then sports physicals were offered at a reduced 
cost. Since then, numerous calls requesting assistance 
have been received. The school based request services 
not provided by them such as dental and immunizations. 


Limited health promotion through health education. 


The role of the school nurse has been limited in many 
respects and school nursing services are too task 
(injury/illness care) focused. Our all baccalaureate 
prepared staff are highly qualified and enthusiastic - 
would like to participate more in health ed planning and 
implementation. 


Outsiders (community persons) entering the school for 
services. 


Limit access hours, provide sign-in/sign-out system 
with name tag, limit the number of persons occupying 
the clinic at a given time (ie. Patient and all of their 
fiiends). 


Services are limited to elementary age children and 
siblings. 


Referral network for middle and high school children. 



67 



What Wofks 10: School Health in Urban Communities 



Section II 



7. Systems Barrier - Privacy /Information 

Four urban health departments in four states identified insurance of confidentiality as a significant barrier to 
collaboration in school health. 



Perceived Barrier 


Efforts to Overcome 


Sharing confidential information. 


We have developed a single consent to release 
information form and have begun to train all 
multi-disciplinary teams working at each site on how to 
use this process. Collaboration across 
departments/disciphnes and integration of services is a 
primary focus of our efforts. 


Confidentiality issues in school health centers. 


We are working through this issue; sharing data, what 
information medically is protected, school policies 
etc... using both lawyers. 


Lack of access to free lunch eligibility hst. 


We have worked with the food service director to secure 
names when the waiver has been signed. Plan to discuss 
this further in an effort to get more parents informed 
regarding the purpose of the waiver; this might be 
possible through the school's media channel or 
publications. 


Access to social security numbers on school files. 


Discussion with superintendent of schools. 



68 



What Wotks m: SdK>ol Heahh in Urban Cooununities 



Section n 



8. Systems Barrier - Technology/Data Systems 

Two urban health departments in two states identified technology barriers which impeded school health 
collaboration efforts. 



Perceived Barrier 


Efforts to Overcome 


Sluggish financial management system. 


EstabUshed a contract with a 330 to eliminate 
difQculties associated with the local governments 
financial management system. 


Data issues merging school and clinic data. 


Joint school/health department planning and 
estabUshment of pohcies and procedures. 



9. Systems Barrier - Liability Issues 

Two urban health departments in two states identified liability concerns as barriers to school health 
collaboration. In both instances the health department took responsibiUty for service provision. 



Perceived Barrier 


Eflforts to Overcome 


School administration will not allow school nurses to 
administer immunizations due to Uability concerns. 


Department sends pubUc health staff out to give 
immunizations. 


FearofUability. 


Health department has to pay to rent any school owned 
faciUty unless school has requested help. Health 
department has to employ and pay nurses who provide 
services on campus, work with school district to provide 
requested services. 



69 



THE URBAN 

HEALTH DEPARTMENT 

SCHOOL CONNECTION: 



SECTION III 



SUCCESS 

STORIES 

IN 

SCHOOL 

HEALTH 



1995 

Profiles of 

Urban 

Health 

Department 

Initiatives 




Providing Health 
Education 


Assuring the Delivery of Health Services 


Collaborating with 
the Community 


Other Components of a 

Comprehensive 
School Health Program 


Other 


J 

S 

1 


is 

u 

n 

n: 

00 

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B 

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5 


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a 

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a 
a 

1 

■s 

1 


1 


Direct Service Delivery 


a 


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u 

c 
u 

00 

a 

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'u 

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B 

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2 

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2 
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10 

c 
to 

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i 


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a: 

a 

5 


Binmnghani, Alabama 


73 


• 










• 


• 


• 


• 




• 


• 




• 






• 


• 


• 


• 






Mobile, Alabama 


74 








• 


• 




































Phoenix, Arizona 


75 


• 


• 




• 


















• 










• 




• 






Tucson, Aiizona 


76 


• 






• 










• 






• 


• 








.• 


• 












77 
























• 






















Berkeley, Califocnia 


78 


• 














• 


• 






• 


• 




















Fairfield, California 


79 














• 
































Fresno, California 


80 


• 




















• 


• 


• 








• 


• 










Long Beach, California 


81 




• 










• 
















• 
















Los Angeles, California 


82 


















• 








• 




















Modesto, California 


83 








• 
















• 


• 




• 




• 


• 










Mwiterey, Calif«nia 


84 








• 




• 


• 












• 








• 












Oakland, California 


85 




















• 


• 




• 










• 




• 






Pasadena, California 


86 






















• 


• 


• 












• 








Sacramento, Califontia 


87 




















• 














• 












San Bernardino, California 


88 


















• 




• 


• 




• 






• 






• 






San Jose, California 


89 












• 










• 


• 


• 










• 










Santa Ana/Anaheim, California 


90 














• 




• 




• 


• 


• 








• 












Santa Rosa, California 


91' 














• 




• 




• 


• 


• 








• 












Stockton, California 


92 






















• 


• 




• 


















Ventura, California 


93 












• 












• 




• 






• 












Colorado Savings, Colorado 


94 





• 
























• 


















Denver, ColcHado 


95 


















• 






• 


• 




















Englewood, Colorado 


96 






















• 










9 














Lakewood, Cdorado 


97 




• 










• 














• 


















Waterbury, Conneticut 


98 


















• 


• 


• 


• 




• 


















Wilmingt<», Delaware 


99 


















• 






• 


• 








• 












Fort Lauderdale, Florida 


100 














































Jacksonville, Florida 


101 




















• 






• 




















Miami, Florida 


102 


















• 






• 


• 








• 


• 


• 


• 






St. Petersburg, Florida 


103 


















• 






• 


• 








• 


• 


• 


• 






Tampa, Florida 


104 












• 






• 




























Atlanta, Georgia 


105 












• 






• 


• 






• 




















Columbus, Georgia 


106 












• 










• 
























Macon, Georgia 


107 












• 


• 














• 


















Savannah, Georgia 


108 












• 














• 




















Honolulu, Hawaii 


109 








• 










• 








• 








• 


• 


• 


• 






Boise, Idaho 


110 






















• 




• 




















Chicago, Illinois 


111 












• 


• 




• 


• 


• 


• 


• 








• 




• 


• 






Peoria, Illinois 


112 












• 


• 




• 


• 






• 




















Evansville, Indiana 


113 












• 












• 






















T(^>eka, Kansas 


114 


















• 
















• 


• 




• 






Widiita, Kansas 


115 










• 








• 






• 


• 


• 



















1995 

Profiles of 

Urban 

Health 

Depaitment 

Initiatives 




Providing Health 
Education 


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116 


















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• 










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Louisville, Kentucky 


117 


















• 






• 


• 










• 




• 






Portland, Maine 


118 












• 








• 








• 






• 












Baltimore, Maryland 


119 




• 








• 


• 


• 


• 


• 


• 


• 


• 




















Boston, Massachusetts 


120 




• 
























• 












• 






Lowell, Massachusetts 


121 


















• 






• 


• 








• 




• 


• 






Ann Arbor, Michigan 


122 








• 






































Flint, Michigan 


123 














• 














• 


















Grand Rapds, Michigan 


124 








• 
















• 


• 










• 










Lansing, Michigan 


125 












• 


• 








• 
























Ml Qemens, Michigan 


126 












• 






• 




























Westland, Michigan 


127 














• 
































Minneapolis, Minnesota 


128 




• 










• 
































St. Paul, Minnesota 


129 














• 
































Jackson, Mississippi 


130 
























• 




• 


















Independence, Missouri 


131 












• 












• 




• 






• 












Kansas Qty, Missouri 


132 






• 






























• 




• 






St. Louis, Missouri 


133 










• 




• 
































Billings, Montana 


134 












• 






• 










• 


















Lincoln, Nebraska 


135 






















• 


• 


• 








• 


• 




• 






Omaha, Nebraska 


136 




• 






























• 




• 








Las Vegas, Nevada 


137 












• 


• 














• 


















Reno, Nevada 


138 














• 
































Albuquerque, New Mexico 


139 


















• 






• 


• 




• 








• 








Manchester, New Hampshire 


140 


















• 






• 


• 








• 




• 


• 






Albany, New York 


141 











• 










• 


























New York, New York 


142 




















• 


























Rochester, New Y<^ 


143 












• 














• 




















Syracuse, New York 


144 
















• 


• 




• 


• 


• 








• 












Charlotte, North CaroUna 


145 












• 






• 




• 


• 


• 








• 


• 




• 






Durham, North Carolina 


146 
















• 


• 




• 


• 


• 








• 


• 


• 








GreensfoOTO, North CaroUna 


147 




• 












• 






























Raleigh, Nordi Carolina 


148 




• 








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• 




• 


• 


• 








• 




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• 






Winstcm-Salem, NcMth Carolina 


149 


















• 




• 














• 










Qeveland, C^o 


150 


































• 












Columbus, CMiio 


151 
























• 
















• 






Dayton, CMiio 


152 




• 




































• 






Oklahoma Qty, Oklahoma 


153 




• 




















• 






















Portland, Oregon 


154 


















• 




• 


• 


• 












• 


• 






Salem, Oregwi 


155 












• 












• 


• 














• 






Allentown, Pennsylvania 


156 




















• 


























Erie, Pennsylvania 


157 












• 










• 




• 








• 


• 




• 






Fhiladelphia, Pennsylvania 


158 














■ 








• 






• 



















1995 

Profiles of 

Urban 

Health 

Depailinent 

Initiatives 




Providing Health 
Education 


Assuring the Delivery of Health Services 


Collaborating with 
the Community 


Other Components of a 

Comprehensive 
School Health Program 


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159 












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San Juan, Puerto Rico 


160 
























• 


• 










• 




• 






Sioux Falls, South Dakota 


161 














• 
































Memphis, Tennessee 


162 


















• 






• 


• 








• 


• 


• 


• 






Nashville, Tennessee 


163 




• 




















• 


• 










• 




• 






Austin, Texas 


164 












• 


• 




• 




• 


• 


• 




















Dallas, Texas 


165 




• 
























• 








• 




• 






Fort Worth, Texas 


166 












• 


• 




• 






• 


• 




















Houston, Texas 


167 




























• 


















Irving, Texas, 


168 












• 


































Laredo, Texas 


169 














• 
































Lubbock, Texas 


170 














• 
































San Antonio, Texas 


171 












• 


































Salt Lake Gty, Utah 


172 


















• 








• 


• 






• 












Burlington, Vermont 


173 












• 










• 


• 


• 








• 


• 


• 


• 






Alexandria, Virginia 


174 




• 




















• 




• 






• 




• 








Portsmouth, Virginia 


175 














• 
































Virginia Beach, Virginia 


176 














• 
































Seattle, Washington 


177 


















• 




• 


• 


• 










• 




• 






Spokane, Washington 


178 
























• 




• 


















Tacoma, Washington 


179 


























• 








• 






• 






Madison, WisccHisin 


180 














• 
































Milwaukee, Wisconsin 


181 




• 












• 






• 


• 


• 




























































































































































































































































































































































































































































































































































































































































































































































































































































































































































































• 






























^^^ 








^^^ 




^^^ 
































What Works m: School Health in Urban Communities 



Successful Initiatives 



Birmingham, Alabama 

Program: Ensly School-based Health Clinic 

Contact: Jany Moore, C.R.N.P., Clinic Manager 

Phone: (205)930-1401 

Start Date: 01-01-87 



Target population: 

Teenage students at Ensly High School. 
Accomplishnients : 

Today, more than 500 students actively participate in the CHOICES program. Nearly half of the 
school's population gathers in small groups for weekly discussions on topics ranging from Chris- 
tianity to the football game last Saturday to abortion. Staff members at the Ensley clinic, who 
treat up to 20 students per day, try to answer their emotional needs in addition to providiing basic 
health care. 

Purpose: 

The school-based health clinic at Ensley High School offers on-site health care ranging from 
treatment for a headache to diabetes testing and advice on birth control. The clinic offers on-site 
prenatal care to teen mothers as well as follow-up care. By eliminating a perceived labels from 
topics like rape counseling, staff helped remove the stigma many teens associated with counsel- 
ing. 

Has program been evaluated? 
Yes. 

Has program been tried elsewhere? 

Yes. Another health center implemented the program in a high school in 1991. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 

Healthy School Environment 

Physical Education 

Health Promotion for Staff 



Funding Method: 
EPSDT 

Local Tax Dollars 
Medicaid 
Private Foundations 

Estimated Annual Budget: 

$180,000 



73 



Source: 1995 CityMatCH Survey 



What Works m: School Health in Urban Communities 



Successful Initiatives 



Mobile, Alabama 

Program: Healthy Schools/Healthy Communities 

Contact: Joe Dawsey 

Phone: (205) 690-8115 

Start Date: 10-01-94 

Target population: 

Middle school grades six through eight (ages 12-16). The student body is 98 percent black with very 

limited access to health care. 
Accomplishments : 

Accomplishments to date include a needs survey of the students and acquisition of parental consent for 

care. 
Purpose: 

Clinic was scheduled to open in January 1994. Since the October 1994 project start, we have stationed a 

social worker and health educator on site at the school while the clinic was being renovated. 
Has program been evaluated? 

No. 
Has this initiative been tried elsewhere? 

Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Coimseling & Psychological Services 

Healthy School Environment 

Health Promotion for Staff 



Funding Method: 

Health Centers Section 330 PHS 

Corporate Donations 

EPSDT 

Medicaid 

Patient Self-Pay 

Private Foundations 

Estimated Annual Budget: 

$220,000 



Source: 1995 CityMatCH Survey 



74 



What Worics III: School Health in Urban Communities 



Successful Initiatives 



Phoenix, Arizona 

Program: 
Contact: 
Phone: 
Start Date: 



Child Care Consultant/Health & Safety in Child Care Training Project 
Karen Liberante 
(602) 506-6663 
01-01-89 



Target Population: 

The target population includes all who provide service to children between birth and five years of age in 
any type of child care setting. 

Accomplishments : 

Several curriculums have been developed including "The Communicable Disease Flip Chart," "The Safety 
Flip Chart," "County Kids Health Connection," "Child Care Health Newsletter," "Teaching Others About 
Health," the training curriculum for Southwest Human Development Region Nine Teaching Center and 
the CDA and Safety Modules for Central Arizona College. These have been written or prepared for 
educating or training child care, early education and public health professionals. Many CDA Advisors 
have been trained to teach module content to those who provide child care throughout the county. 

Purpose: 

The Health & Safety in Child Care Training Project is designed to foster a working relationship between 
early childhood programs; the agencies that license and monitor the grouped settings; the offices; agen- 
cies; and schools that provide training; and the Public Health Department. 
The goals of this project are: 

• To upgrade the health and safety standards in child health care programs, including preschools, by 
using existing programs or agencies in the state 

• To provide direct training, educational materials and consultation services to other "trainers" of child 
care professionals and related fields. Efforts include identification of health and safety-related risks in 
the child care setting and identification of gaps in information which contributed to these risks 

Has the activity been evaluated? 

Yes. Each part of the program has been evaluated using independent criteria (i.e., attendance, etc.) 
Has this initiative been tried elsewhere? 

Don't know. 



Areas Addressed By Program: 

Health Education 
Health Services 
Community Involvement 
Healthy School Environment 
Health Promotion for Staff" 



Funding Method: 

Social Service Block Grant (Title XX) 
Title X 
County Funds 
State Fimds 

Title V, MCH Block Grant 
(w/Title V fiinding agency) 

Estimated Annual Budget: 

$300,000 



75 



Source: 1995 CityMatCH Survey 



What Woiks ni: Sdiool Heahh in Urban Communities 



Successful Initiatives 



Tucson, Arizona 

Program: 
Contact: 
Phone: 
Start Date: 



Family Resource and Wellness Centers 
Brenda Even, Ph.D. 
(602) 882-2400 
09-01-92 



Target Population: 

• The location of the centers is primarily urban. Fifteen are located in Tucson, 12 are in the Phoenix area 
and four are in Flagstaff. However, two are located in Casa Grande, and three are in the rural areas of 
Concho, Coohdge and Nogales. 

• The Centers that provide, or will provide, primary care services are also situated primarily in urban 
areas. Nine are located in Tucson, nine in the Phoenix area, four in Flagstaff, and one is in Nogales. 

• The centers serve a variety of age groups. Twelve serve elementary students, while six serve high 
school students. One serves children of all ages. Fifteen serve all ages of the community, targeting 
students and their famihes. Most of the centers that serve all age groups reach their clients through the 
school based or school-linked facilities. 

• However, the Pinal County Housing Department Family Resource Center is a notable exception. This 
center offers social services to residents of all ages in a housing project. It is physically situated in the 
housing project and is not affiliated with a school. 

• Seventy-two percent of the centers were able to give an approximate ethnic breakdown of the clients 
they serve. Of these, 53 percent of the clients were Hispanic, 33 percent are Anglo-Saxon, seven 
percent are Native American and three percent are African American. Bilingual staff is necessary in all 
of the centers and is present in most. 

Accomplishments : 

NA 
Purpose: 

Thirty-three centers that provide school-based, school-linked, community services are currently operating 

in the state of Arizona. The planning for three additional centers is in the final stages. Almost all of the 

centers conducted a community needs assessment or survey and have developed their array of services 

based on these assessments. 
Has the activity been evaluated? 

In progress. 
Has this initiative been tried elsewhere? 

Centers in operation throughout state. 



Areas Addressed By Program: 
Health Education 
Health Services 

Counseling & Psychological Services 
Community Involvement 
Nutrition Services 
Healthy School Environment 



Funding Method: 

Charitable Campaigns 

Corporate Donations 

Individual School Support 

Local Social Services 

Private Foundations 

Private Insurance (including HMO) 

State Education Agency 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



76 



What Works ni: School Health in Urban Communities 



Successful Initiatives 



Little Rock, Arkansas 

Program: Mental Health Group Sessions on Health-Related Topics at Central High School 

Contact: Mary Mattheuis, R.N.P. 

Phone: (501)324-2330 

Start Date: 01-01-90 



Target Population: 

High school students. 
Accomplishments : 

Accomplishments to date include much success in assisting students with maintaining sobriety, allowing 
students to discuss problem areas and gain insight into solutions, etc. The sessions are gaining in popu- 
larity with the students and the number of sessions offered has increased. 

Purpose: 

Group sessions are offered in the school-based health center at Little Rock Central High School. These 
regularly scheduled sessions cover topics such as alcohol or drug abuse, male responsibility, female 
responsibiUty, anger control, conflict resolution and parenting classes, etc. These class sessions are 
offered to students-based upon student difficulties experienced in one of the topic areas or by student 
request. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 

Yes. High school based clinic located in a neighboring school district. 



Areas Addressed By Program: 

Coimseling & Psychological Services 



Funding Method: 

NA 

Estimated Annual Budget: 

NA 



77 



Source: 1995 CityMatCH Survey 



What Works m: School Health in Utban QHmnunities 



Successful Initiatives 



Berkeley, California 

Program: Creation of a High School Health Center 

Contact: Rocio Abundis Rodriguiz 

Phone: (510)644-8501 

Start Date: 01-01-91 



Target Population: 

The health center serves all high school students attending either Berkeley High School or East Campus, 

which are the only two high schools in Berkeley. 
Accomplishments: 

NA 
Purpose: 

The adolescent clinic at Berkeley High School is a joint initiative between the City of Berkeley, the 

Berkeley Unified School District and the Berkley Public Education Foundation. 

Services include first aid, primary care, family planning, STD treatment and diagnosis, mental health, 

substance abuse counseling and health education. 
Has the activity been evaluated? 

Yes. Parts of the program have been evaluated depending on the requirements of the granting agency. 
Has this initiative been tried elsewhere? 

Yes. There are many school-based programs in operation. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

First Aid 

Family Planning Services 



Funding Method: 

District or Diocese Educational Office 

EPSDT 

Private Foundations 

City Tax Dollars 

Estimated Annual Budget: 

NA . 



Source: 1995 CityMatCH Survey 



78 



What Works m: School Health in Urtwn Communities 



Successful Initiatives 



Fairfield, California 

Program: Immunization Clinic 

Contact: Roberta Femrite 

Phone: (707)421-6660 

Start Date: 07-01-93 



Target Population: 

The clinic serves a high monolingual Hispanic population. 

Accomplishments : 

The clinic consistently serves between ten and 20 families during the two hours of operation. 

Purpose: 

Collaboration between the Pubhc Health Division and a Healthy Start school in Vacaville, California. 
The Healthy Start site is a community center run by the City of Vacaville. We operate an immunization 
clinic there one Saturday each month. Our supplies are stored on site. A pubhc health nurse stafife the 
clinic and gives all of the immunizations. The Public Health Division provides the vaccines. The school 
nurse has arranged for parent volimteers and school nurse volunteers to do reception and immunization 
screening, respectively. She has also actively advertised the clinic. This school quahfied as a Healthy 
Start site because of the high proportion of free and reduced limches and limited EngUsh proficiency in 
students. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 

Yes. At another Healthy Start school. However, it was not successful, not promoted and not advertised 
actively. 



Areas Addressed By Program: 

Health Services 



Funding Method: 

Local Tax Dollars 
Matching Federal Funds 

Estimated Annual Budget: 

$3,000 



79 



Source: 1995 ChyMatCH Survey 



What Works ED: School Health in Urban Communities 



Successful Initiatives 



Fresno, California 

Program: Black Infant Health 

Contact: Centhy Handsford, F.N.P. 

Phone: (209) 445-3307 

Start Date: 05-01-93 



Target Population: 

Pregnant and parenting Afiican-American teens. 

Accomplishments: 
NA 

Purpose: 

We have successfully contracted with a high-need school to provide a school nurse to case manage preg- 
nant and parenting African-American teens in order to reduce Afirican-American infant mortality. It is in 
conjunction with our Black Infant Health Program. 

Has the activity been evaluated? 
Yes. Independent. 

Has this initiative been tried elsewhere? 

We are currently developing a model for the state to be repUcated in other health jurisdictions. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 

Healthy School Environment 

Case Management 



Funding Method: 

Individual Donations 
Title y MCH Block Grant 
(w/Title V funding agency) 

Estimated Annual Budget: 

$200,000 - $300,000 



Source: 1995 CityMatCH Survey 



80 



What Works ni: School Health in Urban Communities 



Successful Initiatives 



Long Beach, California 

Program: Mobile Pediatric Clinic Coalition 

Contact: Ron Arias 

Telephone: (3 10) 570-40 1 1 
Start Date: 02-01-95 

Target Population: 

The Mobile Pediatric Clinic Coalition has been meeting for two years to develop the concept and funding 

for a clinic that would serve low-income children in schools in medically underserved areas of Long 

Beach. 
Accomplishments : 

The clinic will offer a fiill array of primary care services at no cost to cUents and link up cUents with a 

"medical home." Medicaid and insurance will be accepted. 
Purpose: 

The purpose of the Mobile Pediatric Clinic Program is to improve the health status of low-income and 

minority children in Long Beach through increased access to basic and preventive health care services. 

The program objectives and methods are: 

• To provide basic and preventive health care services, including immunizations, at locations easily 
accessible to low-income and immigrant femilies; 

• To develop an ongoing coaUtion of individuals and organizations dedicated to securing funding and 
organizing and maintaining a mobile pediatric van; and 

• To design ethnic and language-specific educational programs to educate parents in low-income and 
minority femihes on such topics as the importance of preventive health care, proper nutrition and child 
safety. 

Has the activity been evaluated? 

No. 
Has this initiative been tried elsewhere? 

Don't know. 



Areas Addressed By Program: 

Health Education 
Health Services 
Commimity Involvement 



Funding Method: 

Private Foundations 

Estimated Annual Budget: 

$200,000 



81 



Source: 1995 CityMatCH Survey 



WhatWoiksin: SdioolHeahh in Uiban Communities 



Successful Initiatives 



Los Angeles, California 



4 



Program: 
Contact: 


Child Health Demonstration Project 
Marilyn Burke 
John DiCecco 


Phone: 
Start Date: 


(213) 240-8040 or (213) 625-5354 
09-30-92 



Target Population: 

The target population is low-income, medically underserved children and their siblings, kindergarten 
through sixth grade students. 

Accomplishments: 

Illnesses in children are detected in earUer stages through this program. It is the first time Los Angeles 
Unified School District (LAUSD) nurse practitioners can prescribe medication for children at school sites 
and treat minor acute conditions. Consultation and medical backup are provided by Department of 
Himian Services pediatrician preceptors. Children are able to remain in school or return to school soon 
after treatment. 

Purpose: 

The Child Health Demonstration Project is a partnership program between the LAUSD and the County of 
Los Angeles Department of Human Services. Pre-kindergarten through sixth grade students are being 
served at school sites to improve health care delivery to children. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

NA 



Funding Method: 



EPSDT 

Medicaid 



Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



82 



What Works ni: School Heahh in Urban Communities 



Successful Initiatives 



Modesto, California 

Program: Healthy Start and Cal-Leam 

Contact: Cle Moore or Nancy Fisher 

Phone: (209) 558-7400 

Start Date: 09-01-93 



Target Population: 

One community includes low income Asians, Hispanics, African-Americans and Caucasians. Another 
community exists on the south-side of the city and primarily serves low-income Hispanics. A third 
community is located on the westside of the county where the population is primarily Hispanic. 

Accomplishments : 

Since Healthy Start programs, we have recently become involved in broadening our focus to developing 
the communities through participating in planning with the schools for a Sierra grant. 

Purpose: 

The most successful initiative involving school health was the collaboration and planning for the Healthy 
Start project with the schools. The health department stafiFparticipated in the planning and grant applica- 
tion process. Initial health care services were provided by the public health department until other health 
care providers could be obtained. The health department continues to assess service needs and participate 
on the task force. 

Another activity involving the schools and public health partnership is the Cal-Leam Program. This 
program also includes social services and focuses on pregnant and parenting teens. The goal is to keep 
teens in school who are on AFDC through incentives and punishment (increase/decrease) of money for 
maintaining a "C" average and a $500.00 bonus for graduating from high school. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 

Healthy School Environment 



Funding Method: 

Health Centers Section 330 PHS 

Mental Health Block Grant 

EPSDT 

Individual School Support 

Medicaid 

Preventive Health Services Blk. Grant 

State Social Services Funds 

Social Service Block Grant (Title XX) 

Estimated Annual Budget: 

NA 



83 



Source: 1995 CityMatCH Survey 



What Works ni: School Heahh in Urban Communities 



Successful Initiatives 



Monterey County, California 

Program: 

Contact: Alene Guthmiller 

Phone: (408) 755-4586 

Start Date: 09-01-93 



Target Population: 

Children under five years of age. 

Accomplishments: 
NA 

Purpose: 

Alisal Healthy Start - Through the collaborative, the local health department gives immimizations and 
CHDP exams on site. A pubUc health nurse works two hours per week for planning. 
Monterey Peninsula School District - look alike Healthy Start program provides immunizations and child 
health and disability prevention exams on site and links with primary care services in Seaside. A regis- 
tered nurse works two hour a week for planning. 
Pajaro estabhshed a local site for obtaining X-rays for positive PPD reactors. 

Has the activity been evaluated? 

Yes. Services and linkages have been estabhshed. 

Has this initiative been tried elsewhere? 

Yes. Other Healthy Start programs throughout the state. 



Areas Addressed By Program: 

Health Services 
Commimity Involvement 
Nutrition Services 



Funding Method: 

Local Tax Dollars (county) 

Estimated Annual Budget: 

$5,200 



Source: 1995 CityMatCH Survey 



84 



WhatWofksIII: Sdiool Health in Urban Communities 



Successful Initiatives 



Oakland, California 

Program: Healthy Start School-based Services Program. 

Contact: Janed Fine or Karen Kopriva 

Phone: (510)268-7940 

Start Date: 01-01-92 

Target Population: 

Children at risk. 
Accomplishments : 

The program is designed for families who do not have a regular dentist. The services that are offered at 
the school site include: 

• Education for students, femilies and school personnel. 

• Examinations by dentists. 

• Prophylaxis. 

• Fluoride applications. 

• Occlusal sealant ^plications. 

• Referral for needed dental care. 
Purpose: 

The philosophy of the program is based on the principle of providing access to early preventive services 
to those who are most at risk for health problems, using the most cost effective and scientifically soimd 
methods, delivering services in the school in order to effectively address the community's needs, and 
optimizing the family's concern for dental health care as an entry point for additional dental and other 
health care services. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
Yes. Similar models throughout California. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Healthy School Environment 

Health Promotion for Staff 



Funding Method: 

Corporate Donations 

District or Diocese Education Office 

EPSDT 

Individual Donations 

Local Social Services 

Private Foimdations 

State Education Agency 

Estimated Annual Budget: 

$145,000 



85 



Source: 1995 CityMatCH Survey 



What Worics ni: Sdiool Health in Urban Communities 



Successful Initiatives 



Pasadena, California 

Program: Collaboration with Washington Middle School 

Contact: Cathy Hight 

Phone: (818) 304-0015 

Start Date: 09-01-93 

Target Population: 

Young teens 12 to 14 years of age. 
Accomplishments: 

NA 
Purpose: 

Collaborative case management of young teens in middle school. Includes classes, practices, learning 

events and hands-on participation. Practical National Education i.e., ''What to eat at McDonalds." 
Has the activity been evaluated? 

No. University of South Dakota evaluation team is currently developing an evaluation component. 
Has this initiative been tried elsewhere? 

Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Coimseling & Psychological Services 

Community hivolvement 

Nutrition Services 

Physical Education 

Career Planning Relationships 



Funding Method: 

Charitable Campaigns 
EPSDT 
Medicaid 

State Education Agency 
Black Infent Health Grant 
Prenatal Outreach Grant 
Healthy Start Funds 
Title V, MCH Block Grant 
(w/Title V funding agency) 

Estimated Annual Budget: 

$200,000 



Source: 1995 CityMatCH Survey 



86 



What Works m: School Health in Urban Communities 



Successful Initiatives 



Sacramento, California 

Program: Preventive Dental Health Project "Smile Keepers" 

Contact: Jan Fleming 

Phone: (916)366-2171 

Start Date: 1980 

Target Population: 

37,765 low-income preschool through sixth grade children, their parents and teachers in a school setting. 
Accomplishments : 

• Provide on-going, age appropriate, dental health education, including nutrition and tobacco prevention 
through a series of classroom lessons throughout the school year. 

• Provide daily fluoride tablets to students with parental permission, provide dental health instruction and 
supplies for daily classroom brushing and flossing. 

• Provide teacher workshops for all new teachers and annual updates for all continuing teachers (1,065 
teachers). 

• Provide annual dental health presentations for parents at 84 preschool sites. 

• Provide dental screening, referral and follow-up for participating children. 
Purpose: 

To promote oral health through the use of fluoride, behavior modification, responsibihty, screening, refer- 
ral and follow-up. 

The Smile Keepers Program is a school-based oral health promotion program targeting 37,765 preschool 
through sixth grade students, their parents and teachers. This state-funded program has been in existence 
since 1980. The program consists of daily fluoride supplements, daily toothbrushing, optional flossing, 
three educational classroom visits by registered dental hygienists, dental screening and follow-up and 
parent presentations for Head Start and state funded preschool programs. The presentations promote oral 
health through the use of fluoride, brushing/flossing skills, self-responsibility and behavior modification. 

Has the activity been evaluated? 

Fluoride compliance and toothbrushing effectiveness have been evaluated. 

Has this initiative been tried elsewhere? 

This is part of a statewide dental disease prevention program. 



Areas Addressed By Program: 

Health Education (dental, nutrition 

and tobacco) 
Health Services (dental) 



Funding Method: 

Local Tax Dollars 
State Tax Dollars 
Federal Tax Dollars 

Estimated Annual Budget: 

$275,000 



87 



Source: 1995 CityMatCH Survey 



WhatWoiksm: Sdiool Heahh in Uiban Connnunities 



Successful Initiatives 



San Bernardino, California 

Program: NA 

Contact: Linda Levisen or Betty Ansley 

Phone: (909) 388-4106 or (909) 387-6240 

Start Date: 01-01-93 



Target Population: 

Pregnant and parenting teens and their in^ts. 

Accomplishments : 

Through the Healthy Start Initiative, public health nurses have been identified as the program coordina- 
tor/fecilitator to implement Healthy Start services for at-risk femiUes and children. 

Purpose: 

Our goal is to estabUsh linkages with local school district teenage pregnant programs and provide case 
management services. We have a long standing relationship between the pubUc health and county/local 
school districts to provide pubUc health nursing services for at-risk students. 

Has the activity been evaluated? 

Yes. Adolescent Family Life Program (Healthy Start) at Stanford Research Institute. Lodestar Manage- 
ment Information System. 

Has this initiative been tried elsewhere? 
Yes. Throughout California. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 

Health Promotion for Staff 



Funding Method: 

Individual School Support 
State Social Service Fimds 
Healthy Start Grants 
Title V, MCH Block Grant 
(w/Title V funding agency) 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



88 



What Woiks ni: Sdiool Health in Uiban Communities 



Successfiil Initiatives 



San Jose, California 

Program: School-linked Services Program 

Contact: Linda Carpenter 

Phone: (408) 299-4862 

Start Date: 09-01-94 

Target Population: 

The program targets 12 school/community sites in five school districts in the county. Sites selected 
include eight elementary schools, two middle schools and two high schools. These sites already meet state 
criteria for Healthy Start sites and, in some cases, may have received Healthy Start funding. Healthy 
Start fimding targets children and ^milies in school/communities with a combined rate of 50 percent 
AFDC, LEP and free/reduced meals. 

Accomplishments : 

StafiOng patterns vary from one FTE social worker or public health nurse as a case manager in the 
elementary schools to a full multidisciplinary team. A public health nurse, a mental health counselor, 
alcohol/drug counselors, juvenile probation oflBcers and social worker are in the continuation high school 
with the highest need adolescents in the county. 

Nine sites will have a mobile medical unit at the school one day a week to provide the California Health 
Department EPSDT screenings and referrals to the health/hospital system for treatment or follow-up. 

Purpose: 

In August 1994, the board of supervisors approved the School-Linked Services Proposal. The primary 
objectives of the School-linked Services Program are to provide a better integration of services in order to 
provide a more seamless system of care for our highest need children and famihes; to focus on prevention/ 
early intervention and the development of strong collaborations with schools, city government and com- 
munity groups to reduce duplication and fragmentation. 

Has the activity been evaluated? 

We are currently developing an evaluation. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Healthy School Environment 



Funding Method: 

Mental Health Block Grant 

EPSDT 

Individual School Support 

Local Social Services 

Medicaid 

State Education Agency 

Coimty Tax Dollars 

Substance Abuse Prevention Blk. 

Grant 

Estimated Annual Budget: 

$1,200,000 



89 



Source: 1995 CityMatCH Survey 



Wbat Works m: Sdiool HeaMi in Urban Communities 



Successful Initiatives 



Santa Ana, California 

Program: Healthy Tomorrows 

Contact: Tony Edwards 

Phone: (714) 834-7979 

Start Date: 09-01-93 



Target Population: 

Elementary school students, grades kindergarten through fifth, at five targeted elementary schools in the 
Santa Ana Unified School District. 

Accomplishments: 

During 1993-94, 1,998 students seen, including 877 receiving comprehensive health exams and 744 
receiving immunizations. More than 840 students received social services, including 20 families for in- 
depth femily counseling. 1,200 parents participated in parent education. 

An ongoing study of child abuse reports for the zip codes indicates an increase in general child neglect 
cases (influenced by identification of students for social services) with a 20 percent decline in overall 
abuse cases. However, county wide, the overall abuse case rates increased 60 percent. Study of data 
continues to see what impact Healthy Tomorrows has played. 

Purpose: 

To improve incidence of routine health care and immunization compliance, parent education, empower- 
ment and outreach, economic underserved, minority elementary school population through coordinated 
interagency efforts of public and private agencies. 

Through a mobile van, provide physical examinations, ambulatory pediatric health services for minor 
illnesses and injuries, routine immunizations, referrals for more comprehensive health care as needed. 
The mobile imit model has been selected due to severe overcrowding on the school sites. Staffing would 
consist of a pediatrician, registered with the school nurse. In addition, a family response team and 
Ucensed social workers would be stationed at a central site to provide school linked services in prevention, 
counseling and parent education services as well as follow-up to potential child abuse cases. Other staff 
in the areas of Medi-Cal, employment, housing and nutrition would also be available through the pro- 
gram. 

Has the activity been evaluated? 

In progress and includes CHDP rates, Medi-Cal enrolhnent, student attendance, student achievement and 
focus groups. 

Has this initiative been tried elsewhere? 
Yes. Other school districts have 
adopted the model. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 



Funding Method: 

District / Diocese Education Office 

EPSDT 

Individual School Support 

Local Social Services 

Medicaid 

Private Foundations 

State Education Agency 

Title V, MCH Block Grant 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



90 



What Wofks ni: School Health in Urban Communities 



Successful Initiatives 



Santa Rosa, California 

Program: Help for Teen Parents Program 

Contact: Sharon Oman, P.H.N. 

Telephone: (707) 576-4845 

Start Date: 01-01-85 



Target Population: 

Pregnant or parenting teenagers, who conceived prior to age 18. 

Accomplishments : 

Due to new funds called Cal-Leam, the program has been expanding during the 1994-95 year in all 
geographic locations. Impacts on teens have decreased the percent of low birthweight babies. 84 percent 
of mothers who are in school when they enter the program remain in school. We have decreased the 
percent of teen parents involved in child abuse, and 95 percent of enrolled children have a regular health 
provider. 

CUents have been served in Santa Rosa and partially in two neighboring communities due to funding 
constraints. This program is mostly delivered on school sites with some home visits. Recently the social 
woiicer stafThas grown to include public health aides. 

Purpose: 

Services include case management for two or more years with an extensive initial assessment, counseling, 
information and referral on the need for pre/postnatal health care, infant/toddler well care, immuniza- 
tions, school continuation, child care, job counseling, drug/alcohol assessment and referral, transporta- 
tion referral, and life skills counseling. Cal-Leam puts into place a mechanism to sanction or reward "C" 
average students with a $100 bonus each semester and a possible graduation bonus of $500. 

Has the activity been evaluated? 

Yes. Except for the Cal-Leam portion, which is new, the program is evaluated for all participants each 
quarter for certain objectives like school enrollment, immunization levels of children, etc. This is then 
compared with teen parents not enrolled in the program. Evaluations have shown that the program has 
only minimally improved the number of second births to teen parents. 

Has this initiative been tried elsewhere? 
Yes. Throughout California. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 



Funding Method: 

Local Tax Dollars 

State Social Services Funds 

Title V, MCH Block Grant 

Estimated Annual Budget: 

$500,000 



91 



Source: 1995 CityMatCH Survey 



What Woiks ni: SdKX>l Health in Urban Coimnunhies 



Successful Initiatives 



Stockton, California 

Program: King Family Center (Healthy Start) 

Contact: Roger Deshenes 

Telephone: (209) 953-4666 

Start Date: 01-01-93 



Target Population: 

Dr. Martin Luther King Jr. Elementary School is an urban school in central Stockton with an ethnically 
diverse and economically disadvantaged population. It stands at the center of a neighborhood which in 
recent years has been troubled by serious crime, drug trafficking and gang activity. An influx of immi- 
grants from Mexico and Southeast Asia has created pockets of people who feel isolated and unsure of 
how to receive help. The impact on King School students is poor attendance, transiency and low aca- 
demic achievement. Through multilingual needs assessment, we foimd three major areas of concern for 
King School femihes: basic health care, neighborhood safety and femily support through social services. 

Accomplishments: 

From 1977 to 1991, King School was under a court-enforced busing plan. In 1992, King once again 
became a neighborhood school. In order to meet diverse student needs, the school restructured and 
revised its vision to include the needs of the whole family. Under our restructuring plan, four academies, 
each with a different emphasis, were created to promote a femily atmosphere and provide parents with an 
opportunity to choose a direction for their children's education. Beyond academic support services. King 
School offers to students the Primary Intervention Program, student support groups, conflict management 
and other services through the school psychologist and school counselor. The Student Assistance Pro- 
gram was implemented to bring existing student support services together under a case management 
system to improve deUvery. In addition. Health Fairs were held on campus to help address the basic 
health care needs of King School femiUes. 

Purpose: 

King School area femihes have not used available services due to language differences, lack of cultural 
sensitivity, lack of transportation, lack of money or insurance to pay for services and a frustration with the 
agency runaround. By bringing several agencies together under a case management system, it is our 
intent to ease these barriers and increase the use of services. In addition, the King Family Center will 
serve as a community center where neighborhoods come together to create solutions for the problems of 
the neighborhood. Our goal is to empower King School ^miUes to make positive changes in their Uves, 
to strengthen their &mihes and community and to improve the children's chances for academic success. 

Has the activity been evaluated? 
Yes. Outside evaluator. 

Has this initiative been tried elsewhere? 

Yes. There are several Healthy Start grants throughout the state. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 



Funding Method: 

State Legislative Bill 
Healthy Start Grant 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



92 



What Works ID: School Health in Urban Communities 



Successful Initiatives 



Ventura, California 

Program: Child and Adolescent Clinic 

Contact: Kay Maloney 

Phone: (805) 652-5914 

Start Date: 01-01-92 



Target Population: 

Sites are in poor, largely monolingual Spanish community 

Accomplishments : 

The response was positive. We saw ^mihes at the school sites with the support and urging of school 
personnel that were never seen at a regular clinic site. Therefore, we took the premise that famiUes would 
be more comfortable coming to a neighborhood school than a health center. Since then we have estab- 
hshed nine school clinics sites with some providing services one or two times a month. Where we have 
enthusiastic school support, the clinic is a success. Children with suspected health problems are screened, 
identified and referred. Teachers and other school personnel are becoming aware that the children have 
Uves outside the classroom which impact their school performance. 

Purpose: 

Because of the increasing nimiber of multiproblem &milies on school campuses, the health department 
found an opportunity to provide health services (child health screens - EPSDT) via two Healthy Start 
initiatives. 

Has the activity been evaluated? 

Yes, informally. Some schools do far better than others obtaining students and siblings for services; 
younger siblings and others in the community do not take advantage of services like school children. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Coxmseling & Psychological Services 

Commxmity Involvement 

Nutrition Services 



Funding Method: 

Individual School Support 

Medicaid 

OF? Grant 

CHDP 

Title V, MCH Block Grant 

Estimated Annual Budget: 

NA 



93 



Source: 1995 CityMatCH Survey 



What Works M: School Health in Urban Communities 



Successful Initiatives 



Colorado Springs, Colorado 

Program: RAP Coalition - Reduce Adolescent Pregnancy 

Contact: NA 

Phone: (719) 575-8653 

Start Date: 01-01-87 



Target Population: 

Teenagers. 
Accomplishments : 

We work in partnership with other community organizations to promote efifective programs and poUcies. 
We offer speakers, newsletters, educational workshops, information and referral, resource guides, monthly 
meetings and a variety of educational materials. 

The RAP Coalition is the 1992 winner of the Outstanding Lx)cal Coalition Award presented by the Na- 
tional Organization on Adolescent Pregnancy and Parenting. 

Purpose: 

Our goal is to reduce teen pregnancies in El Paso County. We shall work to ensure that sound education 
in femily life and human sexuality is provided for both youth and parents. 

The Reduce Adolescent Pregnancy Coalition was foimded in 1987 by members of the community who 
were concerned about teen pregnancy and prevention. It is felt that, while the family has the primary 
responsibility for teaching children about human sexuality, we may be the most effective when the family 
is joined by health care providers, school and place of worship. The role of the RAP Coalition is to 
encourage teenagers to postpone sexual intercourse. However, if a teenager chooses not to abstain, our 
role becomes one of promoting responsibiUty regarding pregnancy, sexually transmitted diseases and 
interpersonal integrity. 

Has the activity been evaluated? 
NA 

Has this initiative been tried elsewhere? 
NA 



Areas Addressed By Program: 

NA 



Funding Method: 

NA 

Estimated Annual Budget: 

NA 



Source; 1995 CityMatCH Survey 



94 



What Works IH: School Health in Urban Communities 



Successful Initiatives 



Denver, Colorado 

Program: Denver School Based Health Centers 

Contact: Paul Melinkovich 

Phone: (303) 436-7433 

Start Date: 01-01-88 



Target Population: 

Underserved children and youth. 
Accomplishments : 

The major accomplishments to date have been: 

• The development of an understanding among participating agencies describing the nature of their 
involvement with the program. 

• The establishment of school based health centers at four high schools, one middle school and five 
elementary schools. 

• Enrollment of approximately 70 percent of the students at all target schools. 

• Provision of primary health services to more than 30 percent of the students in middle and high schools. 
Purpose: 

The major goal of the health centers is to improve access to primary health care for underserved children 
and youth. Services offered include physical health services, mental health services and substance abuse 
treatment. In addition, health education for both the individual and the group are provided through the 
program. This initiative is a collaborative multiagency endeavor to establish comprehensive 
multidisciplinary primary health care centers at needed Denver Pubhc schools. 

Has the activity been evaluated? 

The evaluation is in progress and the results are not yet available. The evaluation will evaluate changes 
in access to care and health events as perceived by students and their parents. 

Has this initiative been tried elsewhere? 

Yes. Most school-based health centers involve multiagency collaborative efforts to provide services on- 
site. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 



Funding Method: 

Health Center Section 330 PHS 
Mental Health Services Block Grant 
Corporate Donations 
Individual School Support 
Local Tax Dollars 
Private Foundations 
SPRANS Grant 

Substance Abuse Prev. & Tax Grant 
Title V, MCH Block Grant 
(w/Title V funding agency) 

Estimated Annual Budget: 

$600,000 



95 



Source: 1995 CityMatCH Survey 



What Woiks ni: School Health in Urban Cmnmunities 



Successful Initiatives 



Englewood, Colorado 

Program: Teen Moms Program 

Contact: Laura Moth 

Phone: (303) 452-9547 

Start Date: NA 



Target Population: 

Teenage mothers. 
Accomplishments: 

The primary accomphshments have been the education of the teens about parenting, community resources 

and reducing the number of subsequent pregnancies in the population. 
Purpose: 

Health education and referral for pregnant and teenage parents in the Adams County School District. 
Has the activity been evaluated? 

Yes. Ongoing evaluation. 
Has this initiative been tried elsewhere? 

Yes. 



Areas Addressed By Program: 

Health Education 
Community Involvement 



Funding Method: 
Local Tax Dollars 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



96 



What Works m: SdK>ol Health in Urban Communities 



Successfiil Initiatives 



Lakewood, Colorado 

Program: 

Contact: Mary Lou Newnman 

Phone: (303) 239-7001 

Start Date: 01-01-93 

Target Population: 

School children. 
Accomplishments : 

See purpose. 
Purpose: 

The community, schools and the department of health have been involved in many projects that have 

resulted in good relationships. We have attempted many different models of service and have not always 

been successful. 

Although the health department is the lead agency, the schools have been the second most active agency in 

the conununity-wide coaUtion on Teen Pregnancy Prevention, called a Step Up. We are starting our 

second year of the five-year project. 

We worked together on the Robert Wood Johnson grant application for the state. The state is one of the 

finalists, and we are one of three community finaUsts on the state project. 

Partnership in the production of educational videos for AIDS and substance abuse. 
Has the activity been evaluated? 

Don't know. This was another division. Time was donated by the agency involved. I'm not sure of 

specific hours. More information can be obtained by calling. 
Has this initiative been tried elsewhere? 

Don't know. 



Areas Addressed By Program: 

Health Education 
Commimity Involvement 



Funding Method: 
Lx)cal Tax Dollars 
Prev. Health Services Block Grant 

Estimated Annual Budget: 

NA 



97 



Source: 1995 CityMatCH Survey 



What Works m: School Heahh m Urban C(»ninunities 



Successful Initiatives 



Waterbury, Connecticut 

Program: School-linked Health Center 

Contact: Liz Davis 

Telephone: (203) 574-6880 

Start Date: 09-01-94 



Target Population: 

Three elementary schools with a possible fourth. 

Accomplishments : 

Children who have signed permission on record will be transported to the Pediatric Ambulatory Center at 
St. Mary's Hospital for medical and dental care as needed. This program is not funded with all services 
being offered in-kind. In-kind services include the Waterbury Health Department school nurses, St. 
Mary's Hospital medical staff and Medical Star transportation. 

Purpose: 

In 1993, the Board of Education for the City of Waterbury voted not to support a school-based health 
center. Out of concern for the children who have no medical home, the mayor designated a task force to 
consider other ways of ensuring access to health care. A pilot program has been designed which incorpo- 
rates a school-linked health center to assist children in need of medical care. The program is running in 
three elementary schools, with a possible fourth one on-line soon. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Services 

Counseling & Psychological Services 



Funding Method: 

In-Kind Services 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



98 



What Works QI: School Heahh in Urban Conuniinities 



Successful Liitiatives 



Wilmington, Delaware 

Program: School-based Health Centers 

Contact: Karen DeLeeuw 

Phone: (302)739-3031 

Start Date: 01-01-88 

Target Population: 

High school students. 
Accompiishments : 

NA 
Purpose: 

It is Governor Carper's initiative to have school-based health care centers in every high school. Services 

would include medical, nursing, mental health, nutrition and health education. 
Has the activity been evaluated? 

Yes. Final report was concluded in April 1993. The evaluation was based on a review of findings fi^om a 

study of selected high school wellness centers in Delaware. 
Has this initiative been tried elsewhere? 

Yes. Nationwide. Robert Wood Johnson has best information on state initiatives supporting school based 

health care. 



Areas Addressed By Program: 
Health Education 
Health Services 

Counseling & Psychological Services 
Community Involvement 
Nutrition Services 



Funding Method: 

State General Funds 

Estimated Annual Budget: 

$2,800,000 



99 



Source: 1995 CrtyMatCH Survey 



What Works m: Sdiool Health in Uiban C<»i]munities 



Successful Initiatives 



Ft Lauderdale, Florida 

Program: Enhanced School Health Nursing Services 

Contact: Hagel GreUis 

Telephone: (305) 467-4830 

Start Date: 01-01-89 



Target Population: 

Twelve schools identified as medically underserved. Fifty percent are white, 34 percent are black, 12 

percent are Hispanic, 2 percent are Asian and .3 percent are Indian. 
Accomplishments: 

Given the severe limitations of staff and funding, the only impact we have seen, but a very significant one, 

is a slight decrease in teen pregnancies. 
Purpose: 

An enhanced school based nursing grant enabled a public health unit to provide 20 hours per week of 

nurse time in 12 schools identified as medically underserved. Broward County this year has 199,000 

students enrolled in 185 schools. There are 116 elementary schools, 31 middle schools, 22 high schools 

and 16 special centers. 
Has the activity been evaluated? 

Don't know. 
Has this initiative been tried elsewhere? 

Don't know. 



Areas Addressed By Program: 

Health Education 



Funding Method: 

Local Tax Dollars 
State Health Office 

Estimated Annual Budget: 

$402,000 



Source: 1995 CityMatCH Survey 



100 



What Wmks III: School Health in Urban Cotnmuiiities 



Successful Initiatives 



Jacksonville, Florida 

Program: Children's Mobile Dental Unit 

Contact: Steve Slavkin, D.D.S. 

Phone: (904) 630-3282 

Start Date: 11-01-93 



Target Population: 

Low-income children in the second grade. Homeless population. 

Accomplishments : 

Services include cleaning. X-rays, sealants and referrals for further needed care. In the first year of 
service, over 3,000 students were seen. The project has been extremely well accepted by parents, teachers 
and school principals. Scheduling and on-site accommodations depend on the positive relations between 
the health department and the individual schools. The van is now in service on Saturdays to serve the 
homeless population and is staffed by volunteer dentists and assistants from the community. Dental 
health education is provided on the van. 

Purpose: 

The Children's Mobile Dental unit was placed into service with the assistance of grant funds from Johnson 
& Johnson. A laige van, previously used as an on-site laboratory, was refurbished with two dental chairs, 
x-ray machine, and full support functions. The project was planned in collaboration with the coimty 
schools and serves low-income children in the second grade. 

Has the activity been evaluated? 

Yes. The need for follow-up services was identified and as a result, children's dental services are being 
expanded within the pubUc health unit. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 
Health Services 
Community Involvement 



Funding Method: 

Corporate Donations 
Medicaid 

Estimated Annual Budget: 

$174,653 



101 



Source: 1995 CityMatCH Survey 



AVhat Woiks m: School Health in Uiban Communities 



Successfiil Initiatives 



Miami, Florida 

Program: 
Contact: 
Telephone: 
Start Date: 



Adopt-a-School 

Nancy Humbert, M.S.N., A.R.N.P. 

(305)324-2481 

04-01-94 



Target Population: 

NA 
Accomplishments : 

The Greater Miami Chamber of Commerce has taken the lead in estabUshing a committee called the 
Adopt-a-School. Local business leaders and health care providers are encouraged to adopt a school of 
their choice and provides nurses, social workers or health support workers to the school. Some busi- 
nesses give money directly to the Dade County Public Health Unit (DCPHU) to provide service. Others, 
such as health providers, utilize one of the existing staff members. The DCPHU takes the lead role in 
providing orientation, stafT development and quality improvement. 
To date there are two nurses, one social worker and one health support worker to support this program. 

Purpose: 

There have been many new and exciting initiatives. A School Health-Healthy Start merger/pilot, a non- 
violence pilot program and a major school health conference with more than 1,000 participants are just a 
few. Adopt-a-School is probably most successful in that it involves deep commitment on the part of the 
community, DCPS and DCPHU. 

Has the activity been evaluated? 

No. The project is still new. Evaluationwillcommencein April of 1995. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 

Healthy School Environment 

Physical Education 

Health Promotion for Staff 



Funding Method: 

Corporate Donations 
Individual Donations 
Private Foimdations 

Estimated Annual Budget: 

$58,000 



Source: 1995 CityMatCH Survey 



102 



What Wofks ni: School Health in Urban Communities 



Successful Initiatives 



St. Petersburg, Florida 

Program: SHIP - School Health Improvement Project 

Contact: Janet Townsend 

Phone: (813)469-5800 

Start Date: 02-01-89 



Target Population: 

It is an underserved medically needy area with limited services available without involving traveling great 

distances. Elementary, middle and high school children 
Accomplishments : 

The Pinellas County Pubhc Health Unit has just established a primary care clinic in the Tarpon Springs 

Center to provide access to services for those students and famihes with identified or potential health 

problems. 

The schools went from sharing one nurse with seven other schools to full-time aide/nurse coverage. 

Staffing was based on the American Nursing Association recommended model of one nurse per 150 

students. 

The SHIP staffing was a health support aide for Tarpon Springs Elementary, middle and high schools. 

One senior community health nurse was also part time at the high school and the other senior community 

health nurse shared the elementary and middle schools. 

Students are kept in class or returned to class within a short time of receiving health assessment. Provide 

health education. 
Purpose: 

The Pinellas Coxmty School Health Improvement Project was part of the Florida Legislature-funded 

Demonstration Project awarded to four counties in Florida. The initial SHIP was located in Tarpon 

Springs as a feeder system of elementary, middle and high schools. It was part of the grant requirement 

and this area of Pinellas County has the only consistent feeder system. 
Has the activity been evaluated? 

Yes. Florida State University performs the evaluations. 
Has this initiative been tried elsewhere? 

Yes. Most counties in the state now have this program available in their counties. 



Areas Addressed By Program: 

Health Education 

Health Services 

Coimseling & Psychological Services 

Community Involvement 

Nutrition Services 

Healthy School Environment 

Physical Education 

Health Promotion for Staff 



Funding Method: 

State of Florida Grant Program which 
is now part of Categorical School 
Health Funding. 

Estimated Annual Budget: 

$105,000 



103 



Source: 1995 CityMatCH Survey 



What Works m: SdKX>l Health in Urtuui Communities 



Successful Initiatives 



Tampa, Florida 

Program: 
Contact: 
Phone: 
Start Date: 



Health Education and Services in all Schools 

Mary Howard 

(813)272-6200 

09-01-93 



Target Population: 

Students in all schools. 
Accomplishments: 

NA 
Purpose: 

To provide health education programs for students: Smoke Free 2000, safety, personal hygiene, nutrition, 

substance abuse, sexuality. Health services include screenings and first aid all for all schools. All schools 

provide physicals and a health clinic. 
Has the activity been evaluated? 

Yes. 
Has this initiative been tried elsewhere? 

Yes. Statewide. 



Areas Addressed By Program: 

Health Education 
Health Services 



Funding Method: 

State Tax Dollars 

Estimated Annual Budget: 

$4,000,000 



Source: 1995 CityMatCH Survey 



104 



What Works m: School Health in Uriian Communities 



Successful Initiatives 



Atlanta, Georgia 

Program: 
Contact: 
Phone: 
Start Date: 



School Based EPSDT CUnics 
Bobbie Franklin 
(404) 730-4028 
03-01-94 



Target Population: 

The schools selected for this service were elementary schools with the largest number of children on the 
free lunch program the previous year. Services offered only to children on Medicaid. 

Accomplishments : 

Space and stafPto inform parents and schedule ^pointments were provided by the schools. Equipment, 
supplies and staff to do exams and outreach for EPSDT. Referral/follow-up appointments were provided 
by the health department. The Department of Family and Children Services provided a Medicaid special- 
ist to certify eligible children for Medicaid. 
Each school was provided services one day per week. 

In the first three months that services were provided, 337 children were examined. Forty-eight different 
health conditions were detected, and 248 occurrences of these conditions were reported. One hundred 
eighty-eight of these conditions received follow-up, 107 required dental care and 159 needed routine 
tuberculosis testing. Statistics for the second month of service are still being compiled. 
The collaboration between the three agencies has been excellent. Problems exist but are often resolved. 
Expansion of this program will not be possible without additional resources. All three agencies feel that 
this has been a very successful venture to improve the health and learning power of these children. 

Purpose: 

After several months of planning with school, health department and Medicaid administrators, the school- 
based EPSDT services were initiated in March of 1994 at nine pubhc schools in the coimty. 

Has the activity been evaluated? 
Yes. Evaluation of statistical data. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Services 
Community Involvement 



Funding Method: 
EPSDT 
Health Department 

Estimated Annual Budget: 

$9,500 (1st yr. $3,400 start-up) 



105 



Source: 1995 CityMatCH Survey 



What Wnics ni: Sdiool Health in Uiban Communities 



Successful Initiatives 



Columbus, Georgia 

Program: Scoliosis Program 

Contact: Nomita Killings, R.N. 

Phone: (706) 324-0036 

Start Date: 01-01-83 



Target Population: 

Students in junior high and middle schools. 

Accomplishments : 

During 1993-94, 8,128 students or 82 percent of the target population in a 16-coimty area received 
screenings by public health nurses. 

Purpose: 

Students in junior high and high school are screened free of charge by pubhc health nurses. Those stu- 
dents found to have problems are able to receive free follow-up/consultation with an orthopedist on 
contract with the health district. Famihes who are unable to afford follow-up treatment are referred to the 
district's Children's Medical Services Clinic. 

Has the activity been evaluated? 
Don't know. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 
Health Services 



Funding Method: 
Title V, MCH Block Grant 
(w/Title V funding agency) 

Estimated Annual Budget: 

$12,200 



Source: 1995 CityMatCH Survey 



106 



WhatWofksni: SdKwl Health in Urban Communities 



Successful Initiatives 



Macon, Georgia 

Program: 
Contact: 
Phone: 
Start Date: 



Elementary School Health Checks 
Cecil Baldwin 
(912) 749-0015 
10-01-92 



Target Population: 

We are presently in two elementary schools doing Medicaid Health Checks on Medicaid-eligible children. 

Accomplishments: 

We have been able to do additional special projects, as the need arises, such as the second MMR cam- 
paign, hearing and vision checks and evaluation and referrals for medical problems. We have also been 
able to catch health problems which could afTect the child's performance at school. By having the pro- 
gram at school, the children do not have to miss much class time. A normal exam takes about 45 minutes. 
We can also be a resource for the school staff to use as needed. 

Purpose: 

By doing the health check exams at schools, we have encouraged many delinquent Medicaid children who 
are behind on getting physicals that are dictated by Medicaid standards. This should help reduce the 
^ure rate. We have also been able to provide Medicaid Health Checks on Medicaid-eligible children. At 
present, this is our only function. We also have been able to do additional special projects, as the need 
arises, such as the second MMR campaign. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 

Yes. Other coimty health departments in the Atlanta area. 



Areas Addressed By Program: 

Health Education 
Health Services 
Community Involvement 



Funding Method: 

Health Centers Section 330 PHS 
EPSDT 

Estimated Annual Budget: 

$25,000 



107 



Source: 1995 CityMatCH Survey 



What Works m: Sdiool Health in Urban Communities 



Successfiil Initiatives 



Savannah, Georgia 

Program: Health Checks in Schools 

Contact: Bobbie Stough 

Phone: (912) 356-2234 

Start Date: 01-01-95 



Target Population: 

Students in the regional youth detention center, alternative, elementary and middle schools. 
Accomplishments: 

NA 
Purpose: 

A public health nurse has been employed and is being trained to provide health check appraisals in 

elementary and/or middle schools. This nurse will also provide this service to students in the Regional 

Youth Detention Center. A second public health nurse will be employed to provide health services. 
Has the activity been evaluated? 

No. 
Has this initiative been tried elsewhere? 

Don't know. 



Areas Addressed By Program: 

Health Education 
Health Services 
Community Involvement 



Funding Method: 
EPSDT 
Pubhc Health Department Funds 

Estimated Annual Budget: 

$50,000 



Source: 1995 CityMatCH Survey 



108 



What Works ni: School Health in Urban Communities 



Successful Initiatives 



Honolulu, Hawaii 

Program: Comprehensive School Health Program (CSHP) 

Contact: Sachiko Taketa 

Telephone: (808) 733-9040 
Start Date: 01-01-94 

Target Population: 

Rural neighborhood island counties are being targeted where access becomes a major issue. With in- 
creased closing of the agricultural economy, the families are faced with unemployment, no insurance, etc., 
which leads to other psychological problems. 

Accomplishments : 

A needs assessment was done in the spring of 1994. It dramatizes the risk behavior of our youth, espe- 
cially the intermediate level. A news release should provide the department the vehicle to move our 
agenda forward. 

Purpose: 

This program is a public/private partnership designed to look at the issues confronting our youth and 
addressing them through the development of school-based health service centers. Schools and commimi- 
ties are preparing their appUcation proposals should Hawaii be one of the states awarded the implemen- 
tation grant from the Robert Wood Johnson Foundation "Making the Grade." The planning process 
stimulated many challenges to the whole system of school-based services, but it has helped to increase 
awareness of school health. It has also ^ihtated the initiative towards comprehensive school health 
programs and preventive services integrated into the schools. The department's driving forces are the 
school health nurses and Peer Education coordinators. 

Has the activity been evaluated? 

No. We are exploring technical assistance. 

Has this initiative been tried elsewhere? 
No. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 

Healthy School Environment 

Physical Education 

Health Promotion for Staff 



Funding Method: 

Health Department General Funds 

Estimated Annual Budget: 

$30,000 per site 



109 



Source: 1995 CityMatCH Survey 



What Woiks m: Sdiool Health in Urban Communities 



Successful Initiatives 



Boise, Idaho 

Program: 
Contact: 
Telephone: 
Start Date: 



Protective Services for Children and Families 
Ruby Hawkins 
(208) 327-8580 
04-01-94 



Target Population: 

Collaborative effort to provide services to children and ^mihes where children are identified as being at- 
risk of out-of-home placement or at-risk of abuse or neglect. This project limits the age of the children 
served to elementary school. However, since the services will be provided to the entire family, there may 
be older as well as younger children who receive services. The philosophy underlying activities in this 
project is family centered service planning and deUvery. 

AccompHsliments : 

It is anticipated that a total of 50 children and their famihes may receive services at any one time via this 
project. The duration of services for any one family in any one year is a maximimi of 90 days, including 
the 30 days of service plan development. It is possible for services to continue past 90 days but fimds 
other than Title IV-A will need to be used for such services. 

Purpose: 

The Boise Independent School District (BISD), the Central District Health Department (CDHD) and 
R^on IV Department of Health and Welfare (DHW) have entered into an interagency agreement to 
operate a pilot project to provide child protective services to children and their &milies at seven elemen- 
tary school sites in the city of Boise. The overall philosophy includes a commitment to a community- 
based family-centered emergency service plan that will prevent abuse or neglect and/or out-of-home 
placement for a child. The service plan is designed to ensure the femily is able to access services they 
need past the 90 days by themselves. Staff will have extensive contacts and referrals in the local commu- 
nity. 

Has the activity been evaluated? 

Currently in progress. Boise State University of Social Work will provide the technical assistance consul- 
tation to estabUsh the evaluative component for this project. Evaluations will be submitted to the appro- 
priate administrators. 

Has this initiative been tried elsewhere? 
Yes. At other district health/schools. 



Areas Addressed By Program: 

NA 



Funding Method: 

Local Tax Dollars 

Preventive Health Services Blk. Grant 
Title V, MCH Block Grant 
(w/Title V funding agency) 

Estimated Annual Budget: 

$50,000 



Source: 1995 CityMatCH Survey 



110 



Wliat Works ni: School Health in Urban Communities 



Successful Initialives 



Chicago, Illinois 

Program: 
Contact: 
Telephone: 
Start Date: 



School-Linked Health Program 
Miginia York 
(312)747-9919 
06-01-93 



Target Population: 

Chicago Department of Public Health currently operates School-Linked Health Programs. One program 
is located within the Robert Taylor Housing Development, the largest housing development in the country. 
There are six schools within the housing development. The Robert Taylor Housing Development was 
recently listed in a Census Report as the nation's most impoverished community. 

Accomplishments : 

When the program started, more than 80 percent of parents stated that a hospital emergency room was 
their method of medical care. In a class room of 24 kindergartners, ten needed eye-glasses after a vision 
screening. Many parents reported on a survey that no intervention occurred before the program started. 
A dental screening discovered 12 of 27 children had massive dental decay. Gingivitis started to set in with 
this group of five-year old children. For most children, the program provided their first dental exam. One 
school, Woodson North, upon start of the 1993 program, had 78 percent of the children ages five to 14 not 
in compliance with required immunizations. The attendance of this school is 725. When children do not 
return to school with evidence of compliance regarding physical examinations and immunizations, they 
were excluded fi-om school. Woodson North excluded 11 7 children for noncompliance in 1993. Twenty- 
three of these children never returned to school. We are proud that today, the school has a 99.5% compli- 
ance rate. 

Purpose: 

Chicago Department of Public Health is operating a School-Linked Health Program located within the 
Robert Taylor Housing Development, the laigest housing development in the country. 

Has the activity been evaluated? 

Yes. We are currently collecting information and starting the evaluation of the school-linked program. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 

Physical Education 

Health Promotion for Staff 



Funding Method: 
EPSDT 

Patient Self-Pay 
Title V, MCH Block Grant 

Estimated Annual Budget: 

$450,000 



111 



Source: 1995 CityMatCH Survey 



What Works ni: SdK>ol Heahh in Urban Communities 



Successful Initiatives 



Peoria, Illinois 

Program: 
Contact: 
Phone: 
Start Date: 



Project Success 
Alice Kennall 
(309) 679-6018 
07-01-93 



Target Population: 

The project taigeted four elementary schools ^^ilose previous exclusion rates had been high. These schools 
enrolled children who were at great risk for exclusion due to lack of health exams and immunizations. 

Accomplishments : 

A networic of local agencies arranged and conducted a week of physical exams, dental exams, immuniza- 
tions, lead screening and health education in a one-stop center set up at an early childhood center More 
than 488 children received services. 

Purpose: 

Project Success started with a grant from the Illinois State Board of Education to address perceived 
problems that a network of efforts could solve. Peoria chose to address the high number of children 
excluded from school by a state law requiring students to have physical exams, dental exams, lead poison- 
ing screenings and immunizations. 

Has the activity been evaluated? 
Don't know. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 
Health Services 
Community Involvement 



Funding Method: 

Local Tax Dollars 
State Education Agency 

Estimated Annual Budget: 

$50,000 



Source: 1995 CityMatCH Survey 



112 



What Works ni: School Health in Urban Communities 



Successful Initiatives 



Evansville, Indiana 

Program: Health Assessment/Health Education Services 

Contact: C. Block 

Telephone: (812)435-5766 

Start Date: 09-01-91 



Target Population: 

Health assessment and health education services by public health nurses in schools for students, mothers 
and other school age mothers. 

Accomplishments : 
NA 

Purpose: 

The Vanderburgh County Department of Health and the Evansville- Vanderburgh School Corporation 
entered into an agreement for the implementation of health assessment and health education services by 
pubUc health nurses in the schools for students, mothers and other school age mothers. 

Has the activity been evaluated? 

No. However, school staff members and the public health nurses will cooperate in planning the health 
education and health assessment experiences and will consult at regular intervals to ascertain the effec- 
tiveness of teaching topics and counseling sessions. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 

Counseling & Psychological Services 



Funding Method: 

Local Tax Dollars 

Estimated Annual Budget: 

$1,800 



113 



Source: 1995 CityMatCH SurvQr 



What Works ni: ScIkmI Health in Urban Communities 



Successful Initiatives 



Topeka, Kansas 

Program: 
Contact: 
Phone: 
Start Date: 



School Health Services 
Nola Ahlquist-Tumer 
(913) 295-3650 
01-01-70 



Target Population: 

Four suburban school districts with a student population of 3,000 students per district. 

Accomplishments: 

Three years ago, schools districts were forced to begin covering the full cost of the service. To date, only 
one school district has continued to contract for services. 

Purpose: 

For many years the health agency provided school health services in four suburban school districts with 
populations of 3,000 students per district under a contract with a 50/50 cost-sharing split. Unfortunately, 
city and county poUtics forced the government to refuse their share of the cost with the schools. The 
philosophical basis for the service agreement between the schools and the health agency had an obligation 
to meet the health care needs of students and that school was a logical place to approach communicable 
disease and health education issues. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
No. 



Areas Addressed By Program: 

Health Education 
Health Services 
Nutrition Services 
Healthy School Environment 
Health Promotion for Stafif 



Funding Method: 

Individual School Support 
Local Tax Dollars 

Estimated Annual Budget: 

$160,000 



Source: 1995 CityMatCH Survey 



114 



What Works m: SdKwl Health in Urban Communities 



Successfiil Initiatives 



Wichita, Kansas 

Program: 
Contact: 
Phone: 
Start Date: 



North Central Teen Health Station 
Jacquie Stewart 
(316)337-9075 
01-01-88 



Target Population: 

Students of North High School, which is one of nine high schools in the city, and the feeder middle schools 
are eligible for services. 

Accomplishments : 

In the first year, 672 consent forms were signed. The health station now averages more than 1,000 
consent forms signed per year and more than 2,000 visits per year. In 1994 there were 1,170 individual 
students treated out of 1 ,980 visits. The Adolescent Health Program provides resources for students who 
need health care. These services include acute illness care, sports physicals, immimizations, preventive 
health care, counseling and referral services. 

Purpose: 

The North Central Teen Health Station opened in August 1988 with a staJBFof one nurse practitioner and 
a clerk. The faculty at the University of Kansas School of Medicine at Wichita, Department of Pediatrics, 
donated medical service. An advisory committee was established to include students, parents, feculty and 
community members. Students must have a consent form signed by a parent for the services and pay a 
$10 charge each year with no additional charges. 

Has the activity been evaluated? 

Yes. Annually by a state school nurse consultant. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 



Funding Method: 

Patient Self-Pay 
Title X 
State Funding 
Title V, MCH Block Grant 
(w/Title V funding agency) 

Estimated Annual Budget: 

$102,000 



115 



Source: 1995 CityMatCH Survey 



WhatWarksm: Sdiool Health in Urban C<»imiunities 



Successful Initiatives 



Lexington, Kentucky 

Program: Family Resource and Youth Service Centers 

Contact: Phyllis Roberts 

Phone: (606)281-0218 

Start Date: 01-01-78 

Target Population: 

School children 
Accomplishments : 

Family Resource Centers offer: 

• Assistance with full-time child care for children two and three years old. 

• Assistance with after school child care for ages four to 12 years. 

• Health and education services for new and expectant parents. 

• Education to enhance parenting skills and education for preschool parents and their children. 

• Support and training for day-care providers. 

• Health services or referrals. 
Purpose: 

In 1991, the school system contracted with the health department to provide nursing services to the 

Family Resource Centers. Currently there are eight nurses providing services to 16 youth and Family 

Resource Centers. The Centers were developed as a part of the Kentucky Education Reform Act and are 

designed to succeed in school by assisting students and their families with access to community programs 

and information about these programs. 

The mission of the Centers is to create commimity partnerships that are dedicated to helping students and 

their famiUes overcome problems that keep students from succeeding in school. The Centers coordinate 

existing family and youth support services as needed and as resources permit. 

A local advisory council consisting of parents, community representatives, school personnel and students 

helps guide planning for the centers. Open year-round, these centers are staffed with a coordinator, 

assistant and extended health nurse. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Services 
Community Involvement 
Healthy School Environment 



Funding Method: 

Family Resource Funds 

Estimated Annual Budget: 

$185,000 



Source: 1995 CityMatCH Survey 



116 



WhatWofksin: School Health in Uri>an Communities 



Successfiil biitiatives 



Louisville, Kentucky 

Program: Healthy Learners Project 

Contact: Anita Black 

Phone: (502) 574-6660 

Start Date: 03-15-94 

Target Population: 

Students of Fairdale High School live in two major areas of Jefferson County. One area has 10.3 percent 
of its population below the poverty level and has poor access to public transportation. The other area has 
57.8 percent of its population below the poverty level and has better access to pubhc transportation, 
however access to available preventive care has not been a high priority of this area. According to school 
officials, 40 percent of Fairdale students are pregnant or parenting teens, 50 percent smoke, 25 percent 
are obese, 39 percent are on a free or reduced lunch program and the school has an 1 1 percent absentee 
rate and a 5.96 percent drop out rate. 

Accomplishments : 

Staff sees 50-60 patients each day; and these visits include immunizations, examinations, health assess- 
ment, and counseling, etc. Since the center has been open less than one year, we have been unable to 
evaluate improvement in student characteristics. However, according to school officials, less instruc- 
tional time is lost due to health concerns of the students. 

Purpose: 

The Jefferson County Health Department in collaboration with the Fairdale High School Youth Services 
Center has established the Healthy Learners Project, a school-based adolescent health center. A commu- 
nity advisory committee composed of local clergy, legislators, school officials, parents, adolescents and 
health officials has played a significant role in the health center's operation. Full-time staffing includes 
one registered nurse and one medical assistant. In addition, a physician, family therapist and psycho- 
therapist provide two to four hours per week. 

Has the activity been evaluated: 

No. This is a new initiative and wiU be evaluated at the end of the 1995 school year. 

Has this initiative been tried elsewhere: 

Yes. Thirty schools in other Kentucky coimties. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Healthy School Environment 

Health Promotion for Staff 



Funding Method: 
EPSDT 
Preventive Health Services Blk. Grant 

Estimated Annual Budget: 

$65,000 



117 



Source: 1995 CityMatCH Survey 



What Works ni: SdKtol Health in Urban Communities 



Successful Initiatives 



Portland, Maine 

Program: 
Contact: 
Phone: 
Start Date: 



Dental Health Program 
Karen O'Rourke, M.RH. 
(207) 874-8784 
01-01-70 



Target Population: 

Students kindergarten through fifth grade. 
Accomplishments: 

In more than five years we have seen the number of untreated caries drop, an increase in the number of 

decay-free teeth and an increase in the number of sealants. 
Purpose: 

To provide dental health education and screening to all students in kindergarten through the fifth grade in 

the City of Portland. 
Has the activity been evaluated? 

Yes. School survey data from screenings collected. 
Has this initiative been tried elsewhere? 

Yes. Within the state. 



Areas Addressed By Program: 

Health Education 
Health Services 
Community Involvement 
Nutrition Services 



Funding Method: 

Local Tax Dollars 

Preventive Health Services Blk. Grant 

State and Local 

Estimated Annual Budget: 

$105,000 



Source: 1995 CityMatCH Survey 



118 



What Works ni: Sdiool Health in Urban Communities 



Successful Initiatives 



Baltimore, Maryland 

Program: School-based Health Centers 

Contact: Bernice Rosenthal 

Phone: (410)396-3185 

Start Date: 09-01-85 



Target Population: 

The School Based Health Centers are located in eight secondary schools whose communities have signifi- 
cant health risks. The student population is predominately Afiican-American, 40 percent Medicaid eli- 
gible, 30 percent iminsured, and 20 percent privately insured. 

Accomplishments : 

All students attending the clinic schools are provided clinic information and a consent form to be signed 
by a parent or guardian. On average 60 to 80 percent of the school population is registered with the 
center, and 80 to 90 percent of enrolled students are clinic users. 

The Centers provide a wide range of health and social services and include assessment, referrals, general 
and primary care, diagnosis and treatment of minor injuries, femily planning, STD diagnosis and treat- 
ment and sports physicals. All Centers perform routine lab tests, prescribe and dispense medications, 
manage chronic illness, give immunizations, referrals for prenatal care and provide 24-hour emergency 
phone access to physicians. 

Each site also provides mental health counseling and drug and substance abuse programs. Sex education, 
nutrition education, counseling related to high risk adolescent behaviors, AIDS education, weight reduc- 
tion and parenting education. 

The School-based Health Centers program has been widely accepted, and four other provider groups 
have taken an interest in sponsoring the School-based Health Centers in the city. 

Purpose: 

Baltimore's School-based Health Centers started in September, 1985. The program is an expansion of 
traditional school nursing and incorporates a comprehensive range of primary care and primary preven- 
tive services. The Centers are designed to overcome barriers related to confidentiality, transportation, 
appointment schedules that resulted in lost school time, cost, lack of insurance coverage and general 
adolescent apprehension about discussing personal health problems. 

Has the activity been evaluated? 

Yes. Evaluation available on request. 

Has this initiative been tried elsewhere? 
Yes. Rephcated nationally. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 



Funding Method: 

Health Centers Section 330 PHS 
Mental Health Services Blk Grant 
EPSDT 

Individual School Support 
Local Tax Dollars 
Private Insurance (including HMO) 
SPRANS grant 

Substance Abuse Prev. Tax Grant 
Title V, MCH Block Grant 
(w/Title V funding agency) 

Estimated Annual Budget: 

$2,622,000 



119 



Source: 1995 CityMatCH Survey 



What Worics m: Sdiool Health in IMtan CtMmnuiiities 



Successful Initiatives 



Boston, Massachusetts 

Program: "Fcwtball + Cigarettes = Trouble," A Photonovel About Smoking. 

Contact: L. Comfort 

Phone: (617) 534-5395 

Start Date: 09-01-93 

Target Population: 

The project area includes the students of St. Peter's School in South Boston. 

Accomplishments : 

Students are now using the booklet to teach younger children in their schools about smoking and what 
their story means. During this period the children have learned not only about smoking and tobacco use, 
but about working in groups, the responsibihty of leadership and the pride of accomphshment. The 
booklets are presented to the students in conjunction with a celebration party. Other pubhc health nurses 
will use these booklets throughout the city as a way of introducing discussions about smoking. 

Purpose: 

Seventeen seventh graders at St. Peter's School in South Boston are in the process of completing a two- 
year project during which they created a photonovel book formatted like a comic strip that tells a story but 
contains photogr^hs instead of cartoons. Students focus on a problem and then are able to express their 
thoughts in ways that are relevant to themselves and their peers. 

Has the activity been evaluated: 
No. 

Has this initiative been tried elsewhere: 
No. Not in this format. 



Areas Addressed By Program: 

Health Education 
Commxmity Involvement 
Health Promotion for Staff 



Funding Method: 

Local Tax Dollars 
Tobacco Control Funds 

Estimated Annual Budget: 

$2,500 (for printing) 



Source: 1995 CityMatCH Survey 



120 



What Works ni: School Health in UrtMn Communities 



Successful Initiatives 



Lowell, Massachusetts 

Program: 

Contact: Catherine Brousseau 

Telephone: (508)446-1623 
Start Date: 



Target Population: 

NA 
Accomplishments : 

We are now closer to the N.A.S.N. stafiBng regulations and have greatly enhanced our school health 
services program. 

Purpose: 

Our most successful initiative was getting our City Manager to set aside $250,000 from the State Educa- 
tion Reform Act enabling us to hire ten new school nurses and thus reducing our nurse to student ratio to 
1:750 down from 1:1,400. 

Has the activity been evaluated? 

Yes. It is evaluated monthly and helping provide better nursing services. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Coimseling and Psychological Services 

Community Involvement 

Nutrition Services 

Physical Education 

Health Promotion for Staff 



Funding Method: 

Educ. Reform Act of Massachusetts 

Estimated Annual Budget: 

$250,000 



121 



Source: 1995 CityMatCH Survey 



What Works m: Sdiool Health in Urban C<»imunities 



Successful Initiatives 



Ann Arbor, Michigan 

Program: Mandate for Care Program and K-12 Record Review 

Contact: Linda Lantry 

Phone: (313)484-7200 

Start Date: 01-01-90 

Target Population: 

Kindergarten through 12th grade students. 
Accomplishments : 

In the 1994-95 school year, 5,345 records were processed with 77.6 percent completely immimized. We 

review kindergarten though 12th grade school reports twice a year. Wiih 8,260 new students, 97.4 

perecent were in compliance for the 1994-95 school year. 
Purpose: 

Review childcare program reports once a year for completion rates. 
Has the activity been evaluated? 

Yes. Immunization rates for school starters are assessed each year. 
Has this initiative been tried elsewhere? 

Yes. Statewide 



Areas Addressed By Program: 

Health Services 



Funding Method: 
EPSDT 

Local Tax Dollars 
State Health Department Grants 

Estimated Annual Budget: 

$350,000 



Source: 1995 CrtyMatCH Survey 



122 



What Works ni: Sdtool Heahh in Urban Communities 



Successful Initiatives 



Flint, Michigan 

Program: 
Contact: 
Phone: 
Start Date: 



Special School Immunization Project 

Marilyn Legacy 

(810)257-3634 

01-01-90 



Target Population: 

New School entrants. 
Accomplishments: 

The project awarded certificates and plaques at the end of each year based on the immunization rate 
achieved. Overall, the project was a success in motivating schools to encourage immunization comph- 
ance. Although the rates of individual school districts didn't necessarily improve as much as we would 
have liked, it set the schools in motion to meet the new laws requiring 90 percent compliance of all new 
entrants in November of 1994. 

Purpose: 

In 1990, the Genesee County Health Department established the "Special School Immimization Project." 
We began enrolling school districts in Genesee County with low immimization rates. The project lasted 
five years, at which time all school districts in Genesee Coimty had been enrolled. The purpose was to 
increase to 90 percent or better, each school district's immunization rate for new school entrants. A pubUc 
health nurse worked with the different school districts, setting up immunization clinics as needed in 
individual schools. 

Has the activity been evaluated? 
Don't know. 

Has this initiative been tried elsewhere? 
Dont know. 



Areas Addressed By Program: 

Health Education 
Health Services 
Community Involvement 



Funding Method: 

Health Centers Section 330 PHS 

Medicaid 

Private Foundations 

Estimated Annual Budget: 

$40,000 



123 



Source: 1995 CityMatCH Survey 



What Works m: Sdiool Health in Uiban Communities 



Successful Initiatives 



Grand Rapids, Michigan 

Program: Student Assistance Program 

Contact: Michele Baukema 

Phone: (616)336-3756 

Start Date: 01-01-90 



Target Population: 

Kindei]garten through 12th grade. 
Accomplishments: 

The program to date has provided services to 1 ,8 1 5 students and ^miUes in the Montcalm, Ionia and Kent 

Counties of Michigan. 
Purpose: 

The Student Assistance Program of the Kent County Health Department is a kindergarten through 12th 

grade program that offers a way for schools to address high risk behaviors in youth which interfere with 

their academic performance and/or social development. 

The program is based on three ideas: 

• There is a need for schools and health care organizations to work together to bring about positive 
changes in young people. Combining the expertise of both groups is very valuable when trying to 
confront the complex problems facing youth today. 

• Early intervention into the hves of troubled youth increases the probability of positive changes. If 
students do not receive appropriate attention, their problems may worsen. For this reason, the Student 
Assistance Program is as important in the elementary schools as it is in the high schools. 

• The Student Assistance Program must support the mission and goals of the educational conmiunity. 
The importance of the program is not only in helping youth, but in helping schools to continue provid- 
ing quahty education. 

Has the activity been evaluated? 

Yes. All training programs are evaluated. Currently a long j51e evaluation is being conducted. 
Has this initiative been tried elsewhere? 

Yes. Nationwide in a variety of formats. 



Areas Addressed By Program: 

Counseling & Psychological Services 
Community Involvement 
Healthy School Environment 
Assessment 



Funding Method: 

State Education Agency 

Substance Abuse Prev. & Tax Crrant 

Estimated Annual Budget: 

$300,000 to $350,000 



Source: 1995 CityMatCH Survey 



124 



What Worics ni: School Heahh in Uiban Communities 



Successful Initiatives 



Lansing, Michigan 

Program: School Health Screening Program 

Contact: Elaine Tannenbaum 

Phone: (517)887-4466 

Start Date: 09-01-92 



Target Population: 

Low-income elementary school children in Ingham County. 

Accomplishments: 

In addition to providing a comprehensive health screening, families are referred to health care providers 
as needed, appointments are made for Michcare (Medicaid for children) appUcations where families 
qualify and children are referred on as problems are identified. To date more than 1,000 children per year 
have been screened, and health problems have been identified and referred on for further care. Michcare 
^plications have been identified and immunizations have been given. 

Purpose: 

The School Health Screening Program consists of a team of a nurse assessor, public health nurse and a 
clerk/technician to provide comprehensive EPSDT screenings for low-income elementary school children 
in Ingham County and their respective schools. In particular, the population are low-income famihes with 
no medical insurance. 

Has the activity been evaluated? 

Yes. Follow-up on problems identified and resolved. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 
Health Services 



Funding Method: 

Local Tax Dollars 
EPSDT 

Estimated Annual Budget: 

NA 



125 



Source: 1995 CityMatCH Survey 



What Works ni: SdK>ol Health in Uriun Communities 



Successful Initiatives 



Mt. Clemens, Michigan 

Program: Vision/Hearing Screening 

Contact: Mary Criel 

Phone: (810)469-5188 

Start Date: 01-01-60 



Target Population: 

Preschool and school-age students. 
Accomplishments: 

The program has served more than 100,000 students annually. Approximately ten percent of screened 
students require follow-up supervision. Program staffing consists of one program coordinator, one typist/ 
clerk, 15 vision/hearing employees for the school year only. These tests provide color screenings as well 
and these tests are conducted in all public, preschool and private schools. For hearing failures, we are 
staffed with an ear, nose and throat specialist, physician, audiologist and a health department employee. 
The program continues to be cost shared in 1994-95 school year. 

Purpose: 

These preschool and school-age vision and hearing screenings have been in effect for more than 30 years. 
The program is currently free to students and preschool districts. Recognized and appreciated. Currently, 
free to students and school district. Program staffing consists of one program coordinator, one typist cleik 
and 15 vision/hearing technicians. 

Has the activity been evaluated? 

Yes. State pubUc health depth on-site evaluates a technical assistance program. Peer evaluations by 
Veterans Hospital program coordinator project managers. 

Has this initiative been tried elsewhere? 
Yes. Everywhere for years. 



Areas Addressed By Program: 

Health Services 



Funding Method: 

Local Tax Dollars 

Estimated Annual Budget: 

$285,000 



Source: 1995 CilyMatCH Survey 



126 



What Wofks m: School Health in Uiban Communities 



Successful Initiatives 



Westland, Michigan 

Program: School Enterers Immunization Program (SEIP) 

Contact: R. Thomas Brodnax 

Phone: (313)467-3479 

Start Date: 01-01-94 



Target Population: 

Kindergarten through 12th grade. Head Start and Ucensed day care centers. The School Enterers Immu- 
nization Program monitors the immunization status of all children enrolled in public and private elemen- 
tary and secondary schools, as well as those enrolled in preschool or Head Start programs and Ucensed 
day care centers. 

Accomplishments : 

With the assistance of SEIP, these institutions maintain a very high level of children who have all the 
immunizations ^propriate to their age. Of 33 districts in Wayne County, only one did not achieve its 
required level. SEIP-type programs assure adequate immunization among school enterers and day care 
attendees. SEIP reports school district immunization levels to MDPH by computer discs. These discs 
have replaced an eight inch stack of hard copy. Use of the record-keeping system has made a large inroad 
into the abihty of SEIP to sununarize immunization levels quickly and accurately. 

Purpose: 

The SEIP monitors the immunization status of all children enrolled in public and private elementary and 
secondary schools as well as, those enrolled in preschool or Headstart programs and licensed day care 
centers. Assures that children from birth to 18 years of age are immunized against vaccine preventable 
diseases including polio. Influenza B, measles, mumps, rubella, diphtheria, tetanus and pertussis. A 
related poUcy encourages high immunization levels is the Michigan Department of Education imposes a 
5 percent funding penalty on kindergarten through 12 unless they achieve a 95 percent level of immxmiza- 
tion. 

Has the activity been evaluated? 
Don't know. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Services 



Funding Method: 

Local Tax Dollars 
Medicaid 

Estimated Annual Budget: 

$100,000 



127 



Source: 1995 CityMatCH Survey 



What Woiks m: Sdiool Health in Urban Communities 



Successful Initiatives 



Minneapolis, Minnesota 

Program: Hepatitis B Immunization Project 

Contact: Kathie Amble 

Phone: (612) 673-3814 

Start Date: 10-01-93 



Target Population: 

Adolescents in the Minneapolis Public Schools. 
Accomplishments : 

The program was promoted through all school media channels. Collaboration between school nurse and 

Center staff was used to complete the three injection series and develop a tracking system. To date 500 

students have initiated the series and only five students have been lost to follow-up. All others have 

completed the series or are scheduled to complete the series. 
Purpose: 

The Minneapolis School-based Center has initiated a program to immunize adolescents in the public 

schools against Hepatitis B. All clinic registrants are offered the vaccine. Educational information was 

developed for parents, students and school staff. 
Has the activity been evaluated? 

Yes. Tracking system for the percent of individuals completing the series. 
Has this initiative been tried elsewhere? 

No. 



Areas Addressed By Program: 

Health Education 
Health Services 



Funding Method: 

hidividual School Support 
Vaccine Provided State Health Dept. 
Title V, MCH Block Grant 

Estimated Annual Budget: 

$20,000 (staff and vaccine) 



Source: 1995 CityMatCH Survey 



12S 



What Works ID: School Health in Urban Cmnmunities 



Successful Initiatives 



St. Paul, Minnesota 

Program: Immunization at the Placement Center 

Contact: Diane Holmgren 

Phone: (612)292-7712 

Start Date: 01-01-94 



Target Population: 

The Placement Center is the school district intake center for all kindergarten through 12th grade students 
who are new to the district from out of the county and for all the seventh through 12th grade students who 
are new to the district. 

Accomplishments : 

The program is based at the Placement Center, but also provides immunizations at three elementary 
schools located within neighborhoods with the lowest comphance rates for timely immimizations. This 
year more than 800 immunizations were provided to students and younger siblings, creating an easily 
accessible service and eliminating numerous barriers for these families. 

Purpose: 

Through Immunization Action Plan grant funding, St. Paul Public Health assisted the St. Paul Schools in 
developing systems, collecting data and capturing reimbursement for providing immunizations in the 
Placement Center. 

Has the activity been evaluated? 

No. Not yet. Should be scheduled sometime this year. 

Has this initiative been tried elsewhere? 
Dcm't know. 



Areas Addressed By Program: 

Health Services 



Funding Method: 
Grant Funds 
Reimbursements 

Estimated Annual Budget: 

NA 



129 



Source: 1995 CityMatCH Survey 



What Woiks ni: School Health in Uiban Communities 



Successful Initiatives 



Jackson, Mississippi 

Program: Natural Helpers 

Contact: Jane Stanton 

Phone: (601) 987-3977 

Start Date: 01-01-85 



Target Population: 

Adolescents. 
Accomplishments: 

We are starting some pilot programs in cooperation with the leadership of the extensive service in two 
schools. This is the values and choices program out of Nfinnesota. Our family planning advisoiy council 
through the existing service in to introduce the program. We will cooperate to help implement these pilot 
programs. 

Purpose: 

Catholic Charities provided flmding and leadership for workshop training and ongoing weekly training 
for staff They were also sponsors of "Natural Helpers" an adolescent health issues program. One 
ch^ter at Bailey Neagreet School has been extremely active and successful in presenting programs to 
fellow students, Ustening to peers, directing services and providing school services. These students also 
participated and helped present information at our weddy health department teen maternity clinic. Catholic 
Charities lost its funding this year, and the Bailey program is the only one functioning. 

Has the activity been evaluated: 
No. 

Has this initiative been tried elsewhere: 
Yes. Montgomery County. 



Areas Addressed By Program: 

Health Education 

Community Involvement 

ResponsibiUty 

Respect 

Decision Making 

Justice 



Funding Method: 

Some Drug Grants 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



130 



What Wmics m: School Health in Urban Communities 



Successful hiitiatives 



Independence, Missouri 

Program: Independence Missouri Health Education Project (IM/HEP) 

Contact: Mary Freeman 

Phone: (816)325-7186 

Start Date: 01-01-79 

Target Population: 

Providing health screenings for all seventh grade students. 
Accomplishments : 

In addition to the health screenings and referrals, estabUshing contact with parents, classroom health risk 

presentations and statistical reports for school officials are a few of the program's accompUshments. 
Purpose: 

The purpose of the Independence Missouri Health Education project is to provide health screening for all 

seventh grade students. These screening included health risk appraisal, height/weight, blood pressure, 

step test and hemoglobin. Exit counseling is designed to discuss screening results, health risk assessment 

and set a one-month health goal. 
Has the activity been evaluated? 

Yes. Eighteen months after screening. Findings indicated more than 70 percent of students surveyed were 

either working on same or a new health goal. 
Has this initiative been tried elsewhere? 

Yes. Clay Coimty, Missouri Health Department. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Commimity Involvement 

Nutrition Services 



Funding Method: 

Individual School Support 
Local Tax Dollars 

Preventive Health Services Blk. Grant 
Title V, MCH Block Grant 
(w/Title V fundmg agency) 

Estimated Annual Budget: 

$63,000 



131 



Source: 1995 CityMatCH Survey 



WhatWoiksin: School Health in Urban Commuiiities 



Successful Initiatives 



Kansas City, Missouri 

Program: Annual School Health Conference 

Contact: Chuck Espinoza 

Phone: (816)561-1044 

Start Date: 01-01-80 



Target Population: 

School nurses, health professionals and school administrators. 
Accomplishments: 

One-day conference. 
Purpose: 

An annual one-day conference for school nurses, health professionals and school administrators covering 

topics of relevant interest. Topics are selected by a conference committee. This is the only conference in 

the area that focuses on the concerns of school nurses metropolitan-wide, in two states/seven counties. 
Has the activity been evaluated: 

Don't know. 
Has this initiative been tried elsewhere: 

Don't know. 



Areas Addressed By Program: 

Health Education 

Healthy School Environment 

Health Promotion for Staff 



Funding Method: 

Conference Registration Fees 

Estimated Annual Budget: 

$3,500 



Source: 1995 CityMatCH Survey 



132 



What Works m: School Health in Urban Communities 



Successfiil Initiatives 



St Louis, Missouri 

Program: Child Guard 

Contact: Joan Fiock 

Phone: (314)658-1123 

Start Date: 01-01-82 



Target Population: 

PubUc and nonpublic school students. 

Accomplishments : 

Following this comprehensive campaign, the health records are reviewed on an ongoing basis yearly, and 
the children are immunized prior to entrance into school. 

Purpose: 

The health records of both public and nonpublic schools were reviewed by nurses and clerks. Consent 
forms were then sent home for parental consent as immimization clinics were set up in the school environ- 
ment to provide needed vaccines. 

Has the activity been evaluated? 

The evaluation process is the in-depth subsequent annual immunization record review. 

Has this initiative been tried elsewhere? 
No. 



Areas Addressed By Program: 

Health Education 
Health Services 



Funding Method: 

Local Tax Dollars 
Corporate Donations 

Estimated Annual Budget: 

NA 



133 



Source: 1995 CityMatCH Survey 



What WcMks m: School Health in Uiban Communities 



Successful Initiatives 



Billings, Montana 

Program: Dental Clinic Program For Needy Children 

Contact: Vicki Olson Johnson, R.N. 

Phone: (406) 256-6806 

Start Date: 09-01-83 



Target Population: 

All school-age children in Yellowstone County. 

Accomplishments: 

To date this program continues to be successful and growing in support. It is truly a community effort. 
We also estabUshed a similar program to serve the vision needs of students. Service oiganizations, 
professionals and businesses working together with school nurses. This program has more than 16 years 
in successful existence and has provided many students with eye exams and eyeglasses. 

Purpose: 

All school-age children in Yellowstone County are eligible to request assistance from this program. Jn 
1982-83 a needs assessment was done regarding neglected dental care in school-age children kindeigarten 
through sixth grade. In response to the identified need of many children lacking care due to lack of funds, 
a plea was made to the commimity dentists and an exchange service club organization offered the finan- 
cial and transportation assistance. The dentists were provided minimal reimbursement and gave more 
than two-thirds of the cost as a donation. The health department coordinated all the clinics and services. 
School nurses were the source of die referrals. 

Has the activity been evaluated: 
No. 

Has this initiative been tried elsewhere: 
No. 



Areas Addressed By Program: 

Health Education 
Health Services 
Commimity Involvement 



Funding Method: 

Individual Donations 

Estimated Annual Budget: 

$2,000 



Source: 1995 CityMatCH Survey 



134 



What Worics m: School Health in Uriiaii Communities 



Successful Initiatives 



Lincoln, Nebraska 

Program: Early Intervention Service Coordination 

Contact: Carole Douglas or Patty Baker 

Phone: (402) 44 1 -805 1 or (402) 44 1 -8076 

Start Date: 10-01-92 



Target Population: 

Young children with disabilities in their femihes 

Accomplishments : 

The State of Nebraska passed legislative bill 520 to provide that service coordination to be made avail- 
able to :&niilies with children birth to three years of age with developmental disabilities. This program 
has been contracted to the health department to provide these services and will begin taking referrals 
January 1, 1995. Having already fecilitated several systems change meetings among all three agencies 
involved and experienced improved communication between our agencies, we see this initiative as a major 
accompUshment to improved services for children and families in all agencies involved. 

Purpose: 

The LincoIn.Lancaster Health Department, Department of Social Services and Lincoln Public Schools 
signed a Statement of Agreement in 1993 to implement a collaborative, comprehensive, coordinated 
system of early intervention services for young children with disabiUties and their families in Lincoln, 
Nebraska. Under the terms of this agreement, services coordination staff began assisting families with 
children birth to three years of age in the IFSP process which was developed and piloted by the Lincoln 
Inter-Agency Planning Region Team. Agency procedures and practices, under this agreement, were 
modified to facilitate the goals of the planning team. 

Has the activity been evaluated? 

Yes. Lincoln's interagency planning region team serves as an advisory committee to this program and has 
formally evaluated the program. The femilies who have received services from this grant have also 
formally evaluated this program. 

Has this initiative been tried elsewhere? 

Yes. Services coordination for children birth to three years of age is provided for under Federal law 99- 
457. We are the only community in Nebraska where a health department has the lead role in services 
coordination. 



Areas Addressed By Program: 

Health Education 
Health Services 

Counseling & Psychological Referral 
Community Involvement 
Nutrition Services (educational info) 
Physical Education 
Healthy School Environment 
Health Promotion for Staff 
Managed Care 



Funding Method: 

Medicaid 

State Developmental Disabilities Grant 

Estimated Annual Budget: 

$44,000 



135 



Source: 1995 CityMatCH Survey 



>Vliat Works ni: School Health in Uiban Communities 



Successful Initiatives 



Omaha, Nebraska 

Program: Body Walk 

Contact: Patty Falcone 

Phone: (402) 444-7146 

Start Date: 02-01-94 



Target Population: 

Kindergarten through fourth grade students, 600 students in two to three ethnically diverse schools (25 
percent minority in North Omaha), 100 children and parents at the North Y.M.C.A. branch (African- 
American). 

Accomplishments : 

Three North Omaha elementary schools have completed "Body Walk." 

Purpose: 

This is a cooperative project with the American Heart Association, American Lung Association, Ameri- 
can Cancer Society, University of Nebraska at Omaha Department of Exercise Science, Creighton Uni- 
versity School of Nursing, Dairy Council of Central States, Douglas County Extension Agency and the 
Nebraska Dental AuxiUary. The program "Body Walk," was developed by the Idaho Dairy Council and 
Idaho Dietetic Association, as a participatory health education program for kindergarten through fourth 
grade students. The focus is on good health combined with good nutrition and physical activity. 

Has the activity been evaluated? 

Yes. Evaluation report in spring 95 when the program was completed. The evaluation report method 
used the number of participants, course evaluation and a pretest and posttest. 

Has this initiative been tried elsewhere? 

Yes. Developed in Idaho and previously implemented in Nebraska. 



Areas Addressed By Program: 

Health Education 



Funding Method: 

American Heart Assoc./NE Chapter 

Estimated Annual Budget: 

$7,000 



Source: 1995 CityMatCH Survey 



136 



WhatWofksin: SdKwl Health in Uiban Communities 



Successful Initiatives 



Las Vegas, Nevada 

Program: Kindei^garten Round-Ups 

Contact: Fran Courtney 

Phone: (702)383-1301 

Start Date: 01-01-91 

Target Population: 

Kindeijgarten students. 

Accomplishments : 
NA 

Purpose: 

In cooperation with other community organizations (public, private and not-for-profit), we developed and 
use Kindergarten Round-Ups when physical exams and immimizations are offered at no cost to neighbor- 
hood children. 

Has the activity been evaluated: 

Yes. According to attendance, number of physical assessments done, referrals, immunizations given and 
response percent. 

Has this initiative been tried elsewhere: 
Don't know. 



Areas Addressed By Program: 

Health Education 
Health Services 
Commimity Involvement 



Funding Method: 

Corporate Donations 
Individual School Support 
Donated Corporate Employee Time 
Donated Immunization Materials 
Immunization Program fi-om CDC 

Estimated Annual Budget: 

NA 



137 



Source: 1995 CityMatCH Survey 



WhatWodcsm: Sdiool Health in Urban Cmnmunities 



Successful Initiatives 



Reno, Nevada 

Program: 
Contact: 
Phone: 
Start Date: 



Lnmiinization Climes 
Steve Kutz 
(702) 328-2477 
06-01-94 



Target Population: 

All children who enter school. 

Accomplishments: 
See purpose. 

Purpose: 

Washoe County, Nevada requires that all children who enter into school show proof of up-to-date immu- 
nization status by providing the school district with a card authorized by the district health department. 
Previously, all children were required to get this authorized card at the health department. This resulted 
in long waits and overcrowded fecilities. To improve both access for femihes and immunization levels, 
the health department teamed up with the school district to provide immunization clinics at the schools 
themselves. This way a parent can not only register his or her child for the school year, but get immunized 
at the same time. 

Has the activity been evaluated? 
NA 

Has this initiative been tried elsewhere? 
NA 



Areas Addressed By Program: 

Health Education 



Funding Method: 

Health Centers Sections 330 PHS 
Individual School Support 
Preventive Health Services BIk. Grant 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



138 



What Works m: School Health in Urban Communities 



Successful Initiatives 



Albuquerque, New Mexico 

Program: Pride Project at Cibola High School 

Contact: Gladys Lehman 

Phone: (505) 841-4113 

Start Date: 01-01-89 



Target Population: 

High schools and middle schools. 

Accomplishments: 
NA 

Purpose: 

This is a pubUc/private collaborative project in a high school. A local pediatric group and health depart- 
ment have been collaborating to write grants and get seed money to start a school-based clinic which 
includes a nurse practitioner who staffs a clinic twice a week, a mental health worker and other preventive 
programs in the middle school. The project has been ongoing and growing over the years and is thought 
of as a model of private/public partnership. 

Has the activity been evaluated: 
Don't know. 

Has this initiative been tried elsewhere: 
Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Coimseling & Psychological Services 

Community Involvement 

Physical Education 



Funding Method: 


Corporate Donations 


Local Tax Dollars 


Title X 


Estimated Annual Budget: 


NA 



139 



Source: 1995 CityMatCH Survey 



What Works m: Sdiool Health in Uiban Communities 



Successful Initiatives 



Manchester, New Hampshire 

Program: Healthy Schools Program 

Contact: Maiy Ann Cooney 

Phone: (603) 624-6466 

Start Date: 01-01-93 



Target Population: 

To promote the health and well being of students, &mihes and staff. 
Accomplishments: 

The Healthy Schools Program will accompUsh its mission through an organized and coordinated set of 
policies, procedures and activities designed to promote the health and well-being of students, famihes and 
staff in the following eight areas: 

• Food and nutrition services 

• School health services 

• School environment 

• Community/school integration 

• Work site/employee wellness 

• Health education 

• Guidance/counseling/support services 

• Physical education 
Purpose: 

Manchester's Healthy Schools Program states that health is defined as complete mental, physical, social 
and emotional well-being, not just absence of disease or illness. In addition, wellness is defined as the 
positive healthy life-style one chooses in order to achieve his or her highest potential for well-being. 
Educational achievement is directly related to health and wellness; therefore, the mission of the Healthy 
Schools Program is to provide opportunities, knowledge, skills and the environment necessary to motivate 
students, &mihes, staff and the community to help themselves and others hve healthy, productive Uves. 

Has the activity been evaluated? 

No. Currently working on a method. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 

Physical Education 

Health Promotion for Staff 



Funding Method: 

Local Tax Dollars 

Volenteers 

Inkind Contributions 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



140 



What Works ni: SdKwl Health in Urban Communities 



Successful Initiatives 



Albany, New York 

Program: Dental Health Services 

Contact: M. Di Maiino 

Phone: (518)447-4612 

Start Date: 03-01-94 

Target Population: 

Between 600 and 700 school-age children in the Albany City School District who were identified as being 
in immediate need for dental care. 

Accomplishments: 

All of the 60 taigeted children cc«npleted the dental treatment. The average child had eight fillings and 
dental health education was provided. In total, the children made 294 visits to the clinic. More than 250 
sealants were applied and 460 teeth were restored. 

Purpose: 

The Albany City School District employs one dental hygienist. We met with school administration and 
started a program with a school close to our dental clinic. Children who use the clinic average six to seven 
cavities each. There were 60 of these children enrolled in this school. Our dental staff met with the 
children's parents in the evening at the school where they explained the services of our dental clinic. The 
parents provided medical histories, insurance information and written permission to see their children. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 
Dental Health 



Funding Method: 

Local Tax Dollars 

Medicaid 

Patient Self-Pay 

Private Insurance (including HMO) 

Estimated Annual Budget: 

$9,833 (for personnel only) 



141 



Source: 1995 CityMatCH Survey 



What Woiks m: Sdiool Health in Urban Communities 



Successful Initiatives 



New York, New York 

Program: Expansion of School Health Services 

Contact: Cecilia Fitzpatrick, M.D. 

Phone: (212) 788-4958 

Start Date: 01-01-90 



Target Population: 

School students in New Yoik pubhc schools. 
Accomplishments: 

NA 
Purpose: 

This initiative is the result of a lawsuit against the New York Department of Health. As a result, the 

Department of Health agreed to provide a pubhc health assistant in every pubUc school. This assistant is 

part of a team composed of a nurse and physician. Nurse and physician assignments in schools are 

determined by a ranking of school health needs. 
Has the activity been evaluated? 

No. 
Has this initiative been tried elsewhere? 

Yes. This is a dehvery model based on the "PubUc Health Case Management Plan." 



Areas Addressed By Program: 

Health Education 
Health Services 



Funding Method: 

Local Tax Dollars 

Estimated Annual Budget: 

$35 milhon 



Source: 1995 CityMatCH Survey 



142 



What Wofks m: School Health in Uiban Communities 



Successful Initiatives 



Rochester, New York 

Program: "Vision Care For Kids 

Contact: Nancy O'Mara 

Phone: (716)274-6177 

Start Date: 03-01-92 



Target Population: 

Each year, more than 19,000 students are screened for vision deficits. Approximately 3,000 of these 
students are referred for follow-up due to an abnormal screening. 

Accomplishments : 

During the first two years of operation, the program has provided eye-glasses for more than 1,200 stu- 
dents. As a three-year "demonstration initiative," it has proved successfiil in increasing the number of 
students receiving vision care. A group of health providers, community and county leaders have been 
meeting to implement a long-term solution. 

Purpose: 

After reviewing the annual vision report fi'om the 1990-1991 school year, the lack of Medicaid and health 
insurance with vision riders was creating identified vision problems. Members fi^om the local department 
of social services, department of health. United Way & the Industrial Management Coimcil developed a 
plan to address this concern. The Optometric Society agreed to provide fi-ee eye exams; Baush & Lomb 
agreed to provide firames; two private labs agreed to grind lenses; and the United Way agreed to purchase 
the lenses. Transportation was provided by the distribution of bus tokens and a private transporter The 
Eye Conservation Council agreed to coordinate appointments and transportation. The Industrial Man- 
agement Council provided seed fimds for phones and office supphes to coordinating agencies. Students 
who needed fiirther referrals were referred to the Opthamalogy Group of the Monroe County Medical 
Society. 

Has the activity been evaluated? 

Yes. Data is kept on the number of students and utilization of the vision care for kids program. Abnor- 
mal screenings will be monitored to determine impact on children needing follow-up. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Services 
Community Involvement 



Funding Method: 

Charitable Campaigns 
Corporate Donations 
Local Social Services 
Medicaid 

Professional Contributions 
Non-Profit Agency Funds 

Estimated Annual Budget: 

$6,000 



143 



Source: 1995 CityMatCH Survey 



What Works m: Sdiool Health in IMian Communities 



Successful Initiatives 



Syracuse, New York 

Program: Young Mothers Educational Development 

Contact: Beverly Miller 

Phone: (315)435-3811 

Start Date: 01-01-65 



Target Population: 

Teenage parents in Syracuse, New York. Syracuse and Onondaga County junior and senior high school 
students. 
Accomplishments: 

• Obstetrician, physician assistant and nurse practitioner supervise prenatal, postpartum and femily 
planning services 

• 24-hour medical and crisis coverage 

• Registered nurse available for daily monitoring of pregnant students 

• Community health nurse coordinates health care for outside health providers and community agencies 

• Nutrition education counseling and W.I.C. enrollment on-site 

• Prenatal, childbirth and newborn education 

• Assessment of educational program needs and appropriate grade level curriculum outlines 

• District teachers provide junior and senior high school instruction 

• Special education teacher available 

• Health education class specifically prepared for pregnant and parenting teens 

• Case management services includes individualized service, goal planning, advocacy, referral and sup- 
port 

• Parenting skills, education, support and small group parent/infant learning instruction 

• Group counseling and individualized coimseling on site by referral 

• Licensed infant care center provided daily and for all activities 
Purpose: 

The Young Mothers Educational Development Program is a comprehensive program which provides 
medical, educational, social work and day-care services to promote the health and self-esteem of teenage 
parents. The program is designed to prepare them for responsible parenting and independent living. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Conimunity Involvement 

Nutrition Services 



Funding Method: 

Individual School Support 
Local Social Services 
Local Tax Dollars 
Medicaid 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



144 



What Works m: School Heahh in Urban Communities 



Successful Initiatives 



Charlotte, North Carolina 

Program: Collaboration with Cities in Schools Program 

Contact: R. T. Leddy 

Phone: (704) 336-4763 

Start Date: 01-01-92 

Target Population: 

Risk-identified students in grades kindergarten through 12. 

Accomplishments: 

Cities in Schools students, as a specific cohort, have shown significant increases in scholastic perfor- 
mance and reduced drop out rates. 

Purpose: 

Our Health Department School Health Program collaborates with the community's Cities In Schools to 
provide risk-identified students in grades kindeigarten through 12, case finding and management, CIS- 
specific physical assessments, other screenings, referrals for primary care and referral follow-up. 

Has the activity been evaluated? 

Yes. By continuous measurement of Cities In School student's performance by CIS program and school 
system. 

Has this initiative been tried elsewhere? 
^ Yes. Various urban areas across the United States. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 

Healthy School Environment 

Health Promotion for Staff 



Funding Method: 
LxKal Tax Dollars 

Estimated Annual Budget: 

$100,000 



145 



Source: 1995 CityMatCH Survey 



^liatWMksin: Sdiool HeaMi in Urban Communities 



Successful Initiatives 



Durham, North Carolina 

Program: School Health Services Team 

Contact: Peg Wolfe 

Phone: (919) 560-7700 

Start Date: 10-01-91 



Target Population: 

School nurses, health educators and health department personnel. 

Accomplishments : 

As a result, the School Health Supervisor from the Health Department invited staff to sit in on meetings 
of school system Student Support Services. As issues and needs arise, they are jointly addressed and 
supported. For instance, a subcommittee was formed to address the wellness perspective. 

Purpose: 

We established the team to better coordinate our services in, and share our resources with, the school 
community. We invited school system staff (Coordinator of Comprehensive School Health Program and 
Healthful Living Specialist) to join us. Monthly meetings to share ideas and plans on joint pubUcity, 
evaluation and woilcing together on projects. 

Health Department team monbers iaclude school nurses, health educators, nutritionists assigned to schools, 
a dentist, a family planning nurse and a physician who is assistant health director. 

Has the activity been evaluated: 
NA 

Has this initiative been tried elsewhere: 
NA 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 

Physical Education 

Healthy School Environment 



Funding Method: 

Local Tax Dollars 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



146 



What Works m: School Health in Urban Communities 



Successful Initiatives 



Greensboro, North Carolina 

Program: Adolescent Pregnancy Prevention 

Contact: Mary S^penfield 

Phone: (910) 373-3273 

Start Date: 01-01-86 

Target Population: 

Adolescents at Kiser Middle School in Greensboro and Femdale Middle School in High Point 

Accomplishments: 

Nurses work closely with students at high risk of becoming pregnant. These students receive intense 
counseling and education to help them delay sexual activity, learn the skills to say no to peer pressure, 
encourage interaction and discussion with parents and to understand the responsibilities of parenting. 
When the program started, there were 15 known pregnancies. Last year there were five and this year 
there were two. 

Purpose: 

Guilford County has been the recipient of a grant from the State of North Carolina since 1986 to reduce 
the number of adolescent pregnancies through the development and use of a school-based health and 
education program. Nurses are assigned fiill-time to Kiser Middle School in Greensboro and Femdale 
Middle School in High Point. Nurses provide standard school nursing services for all students at these 
schools to promote healthy life-styles. 

Has the activity been evaluated? 

Yes. An outside evaluation was conducted by the Philhber Research Associates of Accord, New York. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 
Health Services 



Funding Method: 

Lxx5al Tax Dollars 
State Grant Funding 

Estimated Annual Budget: 

$95,915 



147 



Source: 1995 ChyMatCH Survey 



WhatWoiksm: Scbool Healdi in Urban Communities 



Successfiil Initiatives 



Raleigh, North Carolina 

Program: Hospital Alliance for School Health 

Contact: Peter Morris, M.D., M.P.H. 

Phone: (919) 250-4637 

Start Date: 01-08-93 



Target Population: 

The program serves four elementary schools, one middle and one high school in the inner city. Southeast 
Raleigh. 

Accomplishments: 

Prior to the Alliance e^qiansion, 11 school nurses were spread thin serving almost 80,000 students in 94 
schools. The pilot program aims to prove the benefits of intensified school health intervention. 

Purpose: 

The Hospital Alliance for School Health is a community funded and focused pilot program serving four 
elementary schools, one middle and one high school in the inner city. Southeast Raleigh. Privately fimded 
by the County's three local hospitals, the AlUance provides services to improve school performance and 
success of students in the targeted schools. 

Four school nurses are assigned one or two schools each, providing screening, referrals, consulting and 
counseling to students, families and faculty. A school linked clinic, staffed by a clerk, nurse and physi- 
cian assistant with physician consultation, provides clinical assessments. Nurses use case management 
skills for students or &mihes requiring ongoing care, referring the most difiicult cases to a full-time social 
worker. A part-time nutritionist counsels parents, teachers and students and coordinates health fairs. 
Each school chose and implemented a health promotion initiative. 

Has the activity been evaluated? 

Yes. Contracted to education consultants for both process (contracts, referrals, serviced care) and out- 
come indicators (absenteeism, end of school grades supervisions and drop out rates). 

Has this initiative been tried elsewhere? 

Yes. E?q)anded fi'om initial six school sites in urban setting to additional six schools in rural setting in our 
county. 



Areas Addressed By Program: 

Health Education 
Health Services 
Community Livolvement 
Nutrition Services 
Physical Education 
Health Promotion for staff 



Funding Method: 

Corporate Donations 
Private Foundations 

Estimated Annual Budget: 

$600,000 



Source: 1995 CityMatCH Survey 



148 



What Wofks m: School Health in Urban Communities 



Successful Initiatives 



Winston-Salem, North Carolina 

Program: Full-time Nurse at Children's Center 

Contact: Peggy H. Lemon 

Phone: (910) 727-8297 

Start Date: 08-01-93 

Target Population: 

Exceptional children; physically handic^ped, medically fragile, austic, severely/profoimdly handicapped, 
developmentally delayed, trainable mentally handicapped and emotionally handicapped students. 

Accomplishments : 

The nurse in each school provides some direct care. However, the primary role is the assessment, care 
plamiing and cmgoing evaluation of students with special health care service needs in the school setting. 
She also provides training, supervision and monitoring for school staff that participate in direct care to 
students. Students, parents, school staff and administrators are very pleased with this arrangement. 

Purpose: 

Schools that are part of the Winston Salem Forsyth County School system and have an enrollment of 
between 80-100 students. Students are assigned to these schools through the exceptional children's pro- 
gram. The students range in age from birth to 2 1 years. This includes physically handicapped, medically 
fragile, , severely/profoundly handicapped, developmentally delayed, trainable mentally handicapped and 
behavior/emotionally handic^ped students. Many of these students are nonverbal and/or nonambulatory. 

Has the activity been evaluated: 

Yes. The nurses are evaluated on an annual basis by a nursing supervisor and school principal. All 
evaluations have been very positive. 

Has this initiative been tried elsewhere: 
Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Healthy School Environment 



Funding Method: 

Charitable Campaigns 

District or Diocese Education OfBce 

Estimated Annual Budget: 

$62,000 



149 



Source: 1995 CityMatCH Survey 



WhatWofksni: Sdiool Health in Urban CcMiimunities 



Successful Initiatives 



Cleveland, Ohio 
Program: 
Contact: 
Phone: 
Start Date: 



School Collaborative 
Karen K. Butler 
(216) 664-4371 
08-01-94 



Target Population: 

Adolescents 19 and younger. Junior high and high school students in 19 Cleveland schools. 
Accomplishments : 

As a result of this workshop, teams were prepared to provide an interdisciplinary approach to pregnancy 
prevention and management. We identify high-risk students for intervention programming and peer 
support groups. 
Accomphshments: 

• EstabUshed prevention and intervention services in the Cleveland PubUc Schools 

• Provide education and referral services to participating students 

• Assembled a teen prevention coahtion in each school 

• Liaisons formed with adolescent service providers in each school 
Purpose: 

The Cleveland Healthy Family/Healthy Start Project team has integrated outreach staff members into all 
1 9 area middle and high schools within the project area. To kick ofifthis event, a summer symposium was 
held to provide a team approach to pregnancy prevention and management. Personnel from each of the 
middle and high schools came together with parents, student leaders and outreach staff for a two day 
workshop. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
No. 



Areas Addressed By Program: 

Health Education 
Nutrition Services 



Funding Method: 

Preventive Health Services Blk. Grant 
Alcohol Service Board 
Healthy Start 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



150 



What Worics ni: Sdiool Heahh in Ufban Conomunities 



Successful Initiatives 



Columbus, Ohio 

Program: 
Contact: 
Phone: 
Start Date: 



Y.E.S. Program (You're Extra Special) 
Liane Egle 
(614) 645-6244 
03-01-92 



Target Population: 

Children of alcoholics. 
Accomplishments : 

Eleven schools have been served to date. The program has received state and national awards as an 
outstanding prevention program. The staff also received a local award from teachers who are ^miliar 
with the program. Training is provided to school staff, teachers and counselors to make them more aware 
of the needs of children of alcoholics. Training is offered twice a year. 

Purpose: 

You're Extra Special is a 12-week support and education program for children of alcoholics and addicts. 
Children attend group sessions on a weekly basis. The major focus of the program is to deal with parental 
alcohol and drug abuse and help children understand that they are not the cause of the problem. These 
children are four times as likely to develop a substance abuse problem, and the program is designed to 
reduce these risks. Play ther^y, art expression and group discussion are a few of the methods used to 
encourage participation. 

Has the activity been evaluated? 

Yes. Parent satisfaction surveys and training evaluations were completed. Findings show a 30 percent 
increase in issue knowledge. All of the participants completing the program know that children do not 
cause parents to have a drug/alcohol problem. 

Has this initiative been tried elsewhere? 
No. 



Areas Addressed By Program: 

Health Education 

Counseling & Psychological Services 

Health Promotion for Staff 



Funding Method: 

Local Tax Dollars 

Substance Abuse Prev. & Tax Grant 

County Administrative Board 

Estimated Annual Budget: 

$50,000 



151 



Source: 1995 CityMatCH Survey 



What Woiks m: SdKwl Health in lM>an Communities 



Successful Initiatives 



Dayton, Ohio 

Program: 
Contact: 
Phone: 
Start Date: 



Clean Cat Program 
Pat Temple 
(513)225-4514 
01-01-93 



Target Population: 

Kindergarten children. 
Accomplishments: 

We complete approximately 25 programs for 500 kindergarten children each year. 
Purpose: 

An instructional hand-washing program dealing with the prevention of disease. 
Has the activity been evaluated? 

Yes. Informally by written comments from school principals. 
Has this initiative been tried elsewhere? 

Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Health Promotion for Staff 



Funding Method: 

District or Diocese Education Office 
Individual School Support 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



152 



What Wofks III: School Health in Urban Communities 



Successful biitiatives 



Oklahoma City, Oklahoma 

Program: Curriculum for Emotional Competence. 

Contact: Jerry Walker 

Phone: (405)425-4412 

Start Date: 08-01-89 

Target Population: 

Fourth grade students at Mark Twain Elementary School. Demographics include low economic status, 
more than 90 percent are on federal lunch^reakfast program, 33 percent white, 33 percent Latino and 33 
percent African-American. 

Accomplishments: 
NA 

Purpose: 

Curriculimi for emotional competence. The focus is on recognition and identification of feelings, relax- 
ation and problem solving to formulate strategies to "make things better." 

Has the activity been evaluated? 

Yes. Student behavioral observation checks were competed by teachers and impartial third parties. 

Has this initiative been tried elsewhere? 
Yes. PubUshed curriculum a;vailable. 



Areas Addressed By Program: 

Counseling & Psychological Services 
Community Involvement 



Funding Method: 

Local Tax Dollars 

Estimated Annual Budget: 

$5,000 



153 



Source: 1995 CityMatCH Survey 



What Works m: Sdwol Health in Urban C<xnmuiiities 



Successful Initiatives 



Portland, Oregon 

Program: Comprehensive School Based Health Centers 

Contact: Denise Chuckovich 

Phone: (503) 248-3674 

Start Date: 01-01-86 

Target Population: 

16 high school, two middle schools and one elementary school. 

Accomplishments : 

The centers will be staffed with one pubhc health nurse coordinator, nurse practitioner, health assistant 
and a full-time mental health counselor. We will be reallocating health department schools in the next 1 8 
to 24 months and incrementally adding high risk schools as needed. We place a heavy emphasis on health 
promotion with the program. 

Purpose: 

To estabUsh comprehensive school-based health centers in seven of 16 area county high schools. The first 
center was established in 1986. Two middle and one elementary school-based centers will open in 1995. 

Has the activity been evaluated? 

Yes. Evaluations show positive results regarding unproved access, increased use of health and mental 
health services, decreased risk behaviors and a decrease in adolescent pregnancy rates. We are currently 
completing a major evaluation of students, parents and school facility. 

Has this initiative been tried elsewhere? 

Yes. More than 500 school-based health centers nationwide. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Physical Education 

Health Promotion for Staff 



Funding Method: 

Health Centers Section 330 PHS 

Local Tax Dollars 

Medicaid 

Private Insurance (including HMO) 

Title X 

State General Funds 

Estimated Annual Budget: 

$1.7 million 



Source: 1995 CityMatCH Survey 



154 



What Works m: SdMol Health in Uii»n Communities 



Successful Initiatives 



Salem, Oregon 

Program: 
Contact: 
Phone: 
Start Date: 



Adolescent Health Service in Woodburn High School 
Donalda Dodson 
(503) 588-5357 
01-01-93 



Target Population: 

School demographics are rural with a student population of more than 600. Forty percent of the students 

in grades nine through 12 have English as a second language and Spanish as the primary. 
Accomplishments: 

Just being there was a great accompUshment. Parents seeking service for their students. 
Purpose: 

School-linked health service with ofiT-site clinical services for health education, health screening and 

education. 
Has the activity been evaluated? 

Yes. A data evaluation has been done to measure the achievements, objectives and goals. 
Has this initiative been tried elsewhere? 

Yes. Oregon has 18 school-based health centers. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Health Promotion for Staff 



Funding Method: 

State Funds 

Great Start Child Health Program 

Estimated Annual Budget: 

$40,000 



155 



Source: 1995 CityMatCH Survey 



What Wnks ni: Sdiool Health in Urban CMnmuiiities 



Successful Initiatives 



Allentown, Pennsylvania 

Program: Deserve Dental Program/Lehigh Valley Hospital 

Contact: Merry Casey 

Phone: (610)437-7615 

Start Date: 11-01-94 

Target Population: 

School children receiving medical assistance/Medicaid. 

Accomplishments: 

Because private dentist ofiBces are difficult for those without transportation to reach, the pubUc transpor- 
tation system takes them directly to the hospital. In the first six weeks, nine children have been served by 
this program. 

Purpose: 

The Deserve Dental Program of the Allentown Health Bureau was able to establish a relationship with a 
local hospital pediatric dental clinic to care for school-age children. They have allocated three clinics per 
month for the Deserve program in order to provide dental care for children receiving medical assistance. 
This alleviates some of the burden on two dentists in the Lehigh Valley area who care for patients receiv- 
ing medical assistance. 

Has the activity been evaluated? 
NA 

Has this initiative been tried elsewhere? 
NA 



Areas Addressed By Program: 

Health Education 
Health Services 



Funding Method: 

Title V, MCH Block Grant 
(w/Title V funding agency) 

Estimated Annual Budget: 

NA 



Source: 1995 ChyMatCH Survey 



156 



What Works m: School Health in Uiban Communities 



Successful Initiatives 



Erie, Pennsylvania 

Program: School Health Partnership. 

Contact: Charlotte Berringer, R.N. 

Phone: (814)451-6700 

Start Date: 08-01-93 

Target Population: 

A student population of ^proximately, 1,950 students, kindergarten through 12th grade, with one of the 
highest teen pregnancy rates of any district in the county. 

Accomplishments: 

During the 1993-94 school year, 59 referrals were given by the district to the public health nurse. The 
program is proving to be a low cost, low technical intervention that directly impacts the students' ability 
to learn, thus giving them a more stable base to grow towards adolescence. 

Purpose: 

The Erie County Department of Health has placed a pubUc health nurse in two rural elementary schools 
in a northwestern county school district. The nurse provides referrals, case management and femily 
home assessment. The school nurse also assists in well child/immunization clinics in the district. The 
school nurse has become a more visible conununity leader by interacting with families before their chil- 
dren enter school. 

Has the activity been evaluated? 

Yes. A year-end meeting with the health department and school district administration. A survey of 
district personnel was taken also. 

Has this initiative been tried elsewhere? 
No. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 

Healthy School Envirormient 

Health Promotion for Staff 



Funding Method: 

Title V, MCH Block Grant 
(w/ Title V funding agency) 

Estimated Annual Budget: 

$30,000 



157 



Source: 1995 CityMatCH Survey 



What Works m: SdKwl Health in Uiban Ckmununhies 



Successful Initiatives 



Philadelphia, Pennsylvania 

Program: School Health Social Worker. 

Contact: Marilyn Tadlock 

Phone: (215)685-6831 

Start Date: 01-01-94 



Target Population: 

Two Philadelphia elementary schools. 

Accomplishments : 

Through home visiting and on-site activities, in cooperation with the school nurse, they work closely with 

^milies to secure necessary medical care for children. Home visiting is an essential component of this 

project. 

The social workers also provide presentations on child health issues and promote regular use of primary 

health care to community organizations and social service agencies. In addition, they participate in 

neighborhood health ^lirs and other special health-related events. This program won an award from 

CityMatCH in 1994. 

Purpose: 

At two Philadelphia elementary schools, three maternal and child health social workers work to ensure 
that every child in the school is enrolled in a health insurance program. The social workers identify 
uninsured children, inform families about eligibility and entitlements and act as an advocate for &milies 
wiien necessary. 

Has the activity been evaluated? 

Yes. A process evaluation on the implementation and summary on enrollment and follow-up. 

Has this initiative been tried elsewhere? 

Yes. This has been expanded within Philadelphia and is now in as many as five schools. 



Areas Addressed By Program: 

Health Services 
Community Involvement 
Community Health Education 



Funding Method: 
EPSDT 

Local Tax Dollars 
Medicaid 

Title V, MCH Block Grant 
(w/Htle V funding agency) 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



158 



What Wcvks ni: School Health in Urban Communities 



Successful Initiatives 



Pittsburgh, Pennsylvania 

Program: Dental Health Services for Clairton Schcx)l Students 

Contact: Larry Kanterman, D.D.S., M.S. 

Phone: (412)578-8378 

Start Date: 10-01-94 

Target Population: 

Clairton is a city in Allegheny County, Pittsburgh with a population of 9,656. It has experienced serious 
economic problems precipitated by the collapse of the steelmaking industry in the area. 

Accomplishments: 

Dental screening exams have been completed for 200 Clairton students. The County Head Start dental 
van was utilized for this activity. The exams were conducted by dental specialty residents and included an 
assessment of dental caries, malocclusion, oral soft tissue lesions and dental treatment priority. 
Work is now underway to develop a dental office in the school. A dental chair and equipment are being 
donated. A pediodontist with a practice in a nearby town has agreed to staff the ofBce primarily for 
Medicaid reimbursement. Through this initiative, students will have ongoing access to appropriate dental 
care. 

Purpose: 

The purpose of this initiative is to provide clinical dental examinations for all Clairton school children in 
comphance with the Pennsylvania School Code and support the development of a dental program. Al- 
legheny County Health Department is interested in determining the dental needs of County children and 
ensuring that needy children have access to appropriate dental preventive and treatment programs. The 
University of Pittsburgh School of Dental Medicine trains dental residents, and this program can include 
community surveys of dental needs and subsequent program development to address those needs. The 
Coimty, University and School District has combined resources to bring dental care to Clairton students. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 
Health Services 
Community Involvement 



Funding Method: 


District or Diocese Education Office 


Individual School Support 


Local Tax Dollars 


Medicaid 


Pittsburgh University Dental School 


Estimated Annual Budget: 


NA 



159 



Source: 1995 CityMatCH Survey 



WhatWcnksIII: Sdiool Health in Uiban Cranmunities 



Successfiil Initiatives 



San Juan, Puerto Rico 

Program: Summer Camp at the Villa Granada School 

Contact: Maternal & Child Division 

Phone: (809)751-6975 

Start Date: 07/01/94 



Target Population: 

Adolescents. 

Accomplishments: 

During 1994, from April to May, a workshop for parents was offered including such themes as growth 
and development, family planning and stress management. In March of 1994, another workshop was 
offered for adolescents and lasted for one month. In July, 1994, an adolescent summer camp was orga- 
nized for the preparation of health promoters. The camp covered educational, cultural and recreational 
activities as well as life-styles modification. The experience was beautiful, with an excellent participation 
of students. These students are acting now as &cihtators for the clinics. 

Purpose: 

School authorities had requested the services of the health department at this specific school due to its 
high incidence of drug use, vandalism, aggressiveness towards teachers, delinquency, etc. The maternal 
and child health staff adopted the school for practically six months during which different activities were 
oiganized. 

Has the activity been evaluated? 

Yes. A written evaluation was obtained from every participant. 

Has this initiative been tried elsewhere? 
No. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Commimity Involvement 

Healthy School Environment 



Funding Method: 

Local Tax Dollars 
Private Contributions 

Estimated Annual Budget: 

$10,000 



Source: 1995 CityMatCH Survey 



160 



What Works in: Sdiool Health in Uiban Cmmnunities 



Successful Initiatives 



Sioux Falls, South Dakota 

Program: Second MMR Clinics for Kindeigarten Students 

Contact: Judy Kendall, R.N. 

Phone: (605) 339-7110 

Start Date: 04-01-94 

Target Population: 

South Dakota Kindergarten students in Sioux River Valley. 
Accomplishments : 

32 elementary schools visited and administered second MMR shots to kindergarten students. 
Purpose: 

The Sioux River Valley Community Health Center and the South Dakota State Health Department visited 

32 elementary schools in Sioux Falls to administer second MMR shots to kindergarten students. This 

proved to be a very successful efiFort on everyone's part. Some private practices suppUed the needed staff. 
Has the activity been evaluated: 

Yes. Each school had a 50 percent or greater immunization rate. 
Has this initiative been tried elsewhere: 

Don't know. 



Areas Addressed By Program: 

Health Services 



Funding Method: 

Health Centers Section 330 PHS 
State Health Department 
Private Clinics 

Estimated Annual Budget: 

NA 



161 



Source: 1995 CityMatCH Survey 



What Woiks m: SdKwlHeahfa in Uiban Communities 



Successful Initiatives 



Memphis, Tennessee 

Contact: Kathleen Johnston, R.N., M.S. 

Phone: (901) 576-7882 

Program: Nurses in Memphis City Schools w/focus: Special Needs Children. 

Start Date: 04-01-93 



Target Population: 

Memphis community schools has 106,000 children and approximately 10,000 are classified as special 
education children. There are 160 schools which have two school-based clinics, one nurse at an alterna- 
tive school for pregnant teens and two nurses at three schools with laige numbers of special education 
children. 

Accomplishments: 

Based upon the ongoing interactions, we were able to have a meeting between top level administrators 
firom both institutions to discuss needs and priorities. The door now appears to be open for expansion. 
Other local efforts with the health department have helped to raise the awareness of the new county mayor 
and some new coimty commissioners. They now seem willing to consider school health in the next budget 
cycle. 

Purpose: 

Our newest initiative is the beginning of a replication of the County effort on the city school system. After 
a number of meetings with special education administrators, health department ofi&cials, special services 
staff, and various educators, we started with one nurse housed in a school with 125 special needs and 
issues children. The principal became a convert to the value of school nurses, and we have been able to 
get additional dollars fi'om the school system for a "team leader" school nurse position. She has been 
providing services to two schools with exclusively multiple handicapped children and has spent consider- 
able time woricing with system administrators to develop pathways for implementation of a broader 
school health program, especially for special needs children. 

Has the activity been evaluated? 

Yes. Ongoing informal tracking process that docimients policy and procedure development and the num- 
ber of teachers trained, etc. 

Has this initiative been tried elsewhere? 
Yes. In many other states. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Nutrition Services 

Physical Education 

Healthy School Environment 

Health Promotion for Staff 



Funding Method: 

District Special Education Funding 
Health Department 
Local Tax Dollars 

Estimated Annual Budget: 

$85,000 



Source: 1995 CityMatCH Survey 



162 



What Works m: Sdiool Health in Uitan Communities 



Successful Initiatives 



Nashville, Tennessee 

Program: Rethinking Problem Solving in MCH: Building on Family Strengths 

Contact: Christine Stroebel 

Phone: (615) 340-5648 

Start Date: 07-01-95 

Target Population: 

Public health personnel. 
Accomplishments: 

This guide intends to help you in the most challenging and exciting task of promoting resilience in your 
children. You, like most parents and other care providers, want your children to be able to face adversity, 
overcome it, and be strengthened or even transformed by the experience. Some adversities can be avoided 
but everyone feces adversities as part of life, either in a crisis situation or as a chronic condition. ResiUent 
children can draw on their inner strengths (I AM) to help them develop, and can draw on their social and 
interpersonal skills (I CAN) to help them learn. They can also draw on the resources and support others 
make available (I HAVE). 
Purpose: 

Guidelines for femily participation at the policy and program level: 

• Maintain a broad view of collaboration 

• Expand the definition of successful femily involvement 

• Use innovative ways to identify and recruit femilies 

• Look for opportunities to promote consumer involvement 

• Provide training and support to both consumers and providers 

• Address logistical barriers comprehensively and creatively 

• Be aware ofconsumer bum out 

• Beheve consumer participation is essential 
Has the activity been evaluated: 

No. 
Has this initiative been tried elsewhere: 
No. 



Areas Addressed By Program: 

Health Education 

Counseling & Psychological Services 
Community Involvement 
Healthy School Environment 
Health Promotion for Staff 



Title X 



Funding Method: 



Estimated Annual Budget: 

NA 



163 



Source: 1995 CityMatCH Survey 



What W(»ks m: Sdiool Health in Uiban Communities 



Successful Initiatives 



Austin, Texas 

Program: 
Contact: 
Phone: 
Start Date: 



School-based Health Centers 
Patsy Benavidez 
(512)476-0020 
01/01/93 



Target Population: 

Elementary school-age children and femily siblings. 

Accomplishments: 

Success of program secured an additional $175,000 for the school-based health centers. Increased atten- 
dance rate at one school and increased immunization rates at both schools. Community is aware of 
school-based health centers. 

Purpose: 

School-based Health Centers are located in two elementary schools and are providing health services such 
as well child exams, insuring access and/or referrals to primary health care services, immunizations, 
counseling services, case management services and provide health education services. 

Has the activity been evaluated? 

An evaluation committee has been organized to evaluate the project. 

Has this initiative been tried elsewhere? 
Yes. Throughout the state. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 



Funding Method: 

Local Tax Dollars 

Estimated Annual Budget: 

$328,290 



Source: 1995 CityMatCH Survey 



164 



What Works ni: School Health b Ufban Communities 



Successful Initiatives 



Dallas, Texas 

Program: 
Contact: 
Phone: 
Start Date: 



Adolescent Health Services Educational Component 

Patsy A. Mitchell, R-N. 

(214)670-1950 

10-01-92 



Target Population: 
Accomplishments: 

The following major accomplishments documented numerically: 

• More than 400 presentations provided annually serving more than 5,000 adolescents 

• More than 2,500 high risk adolescents are identified annually 

• More than 1,500 counseling contacts annually 
Purpose: 

Diverse educational programming was designed and conducted within the Dallas Independent School 
District as well as, community centers and churches within the school district's demographic area. The 
purpose is to positively effect the mortaUty and morbidity rates of adolescent population. 
The educational components are as follows: 

• Sexual transmitted diseases 

• Teen pregnancy 

• Drug distribution and abuse 

• Male and female responsibilities 

• Gang involvement/violence 

• Domestic crimes 

• Black on black/Hispanic on Hispanic crimes 

• Peer, family and societal pressures 

• Sexual abuse / date rape 

• Effects of racism, nepotism, sexism, etc. 
Has the activity been evaluated? 

No. 
Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 
Community Involvement 
Healthy School Environment 
Health Promotion for Staff 



Funding Method: 

Preventive Health Services Blk. Grant 

Estimated Annual Budget: 

$262,682 



165 



Source: 1995 ChyMatCH Survey 



What Wnks ni: School Heahh in Uiban Communities 



Successful Initiatives 



Fort Worth, Texas 

Program: Dillow Health Promotion Center 

Contact: Patricia Newcomb 

Phone: (817)531-6146 

Start Date: 09-01-93 



Target Population: 

The clinic serves indigent or miderserved cUents. Roughly 57 percent of clinic cUents are AMcan-Ameri- 
can, 35 percent are Hispanic, and eight percent are Caucasian. Clients have typically experienced mul- 
tiple barriers to care such as poor transportation, long waiting periods for q)pointments, confusing health 
care systems and perceived user unfriendliness of fecilities. 

Accomplishments : 

The center was estabhshed in September, 1993. By the end of the health center's first nine months of 
operation, 53 percent of the Dillow students had received well-child care in the school based clinic. By 
the end of 1994, the center recorded 804 well-child visits, 609 sick visits and 809 immunizations. 

Purpose: 

Dillow Health Promotion Center is a school-based clinic which was created in collaboration with the Fort 
Worth Independent School District to provide primary care to medically needy students. The health 
center provides will child care, including EPSDT exams, care for acute minor iEnesses, immunizations, 
health education and a specialized asthma clinic. 

Has the activity been evaluated: 

Yes. The evaluation was performed by a local nursing college. It found that parents utilized the clinic/ 
center because it was located on campus. 

Has this initiative been tried elsewhere: 
Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 



Funding Method: 

Corporate Donations 

District or Diocese Education Office 

Medicaid 

EPSDT 

Local Tax Dollars 

Patient Self-Pay 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



166 



What Worics m: SdKX>l Health in Uiban Ccnnmunities 



Successful Initiatives 



Houston, Texas 

Program: 
Contact: 
Phone: 
Start Date: 



Houston Violence Prevention Program 
Dr. BiU Wist 
(713) 794-9085 
10-01-92 



Target Population: 

The program focuses on middle school African-American and Hispanic youths. 

Accomplishments: 

A multi&ceted violence prevention education program is provided to youth peer leaders, their parents and 
neighborhood block workers. Community leaders are organized to develop locale-specific strategies to 
prevent violence. Both process and impact evaluation is being conducted of each component of the 
program. The program is being carried out through contractual relationships with two community-based 
organizations and two universities. 

Purpose: 

The Houst(»i Violence Prevention program is a youth violence prevention program flmded by the Na- 
tional Center for Injury Prevention and Control at the Center for Disease Control and Prevention (CDC). 
Six pairs of middle school attendance zones were randomly assigned to participate in a comprehensive 
community and school violence prevention program or served as a comparison school. 

Has the activity been evaluated: 

Yes. Ongoing data collection over a five-year period ending in 1997. 

Has this initiative been tried elsewhere: 
No. 



Areas Addressed By Program: 

Health Education 
Community Involvement 



Funding Method: 
Federal (CDC) 

Estimated Annual Budget: 

$510,886 



167 



Source: 1995 CityMatCH Survey 



What Woiks m: Sdiool HeaMi in Ufban Communities 



Successful Initiatives 



Irving, Texas 

Program: 
Contact: 
Phone: 
Start Date: 



Tuberculosis Skin Testing 
Walter Bosworth 
(214) 721-2461 
01/01/90 



Target Population: 

School age children 

Accomplishments: 

A meeting of health board officials and school board representatives is scheduled to determine if a re- 
quired program of Tuberculosis skin testing is necessary for school children. 

Purpose: 

Irving has an increasing minority population and many minority class children, 5 1 percent, which com- 
prise the pubUc schools population. The incidence of Tuberculosis has jumped dramatically in this area 
of the country. In Texas, Tuberculosis skin tests are no longer required for entry into or advancement 
within school. The health professionals are working with the school administration and board in present- 
ing background information and data to reinstate some Tuberculosis skin testing to better assess the 
Tuberculosis incidence in children. 

Has the activity been evaluated? 
Don't know. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 



Funding Method: 
City Tax Dollars 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



168 



What W(»ks ni: Sdiool Heahh in Urban Communities 



Successful Initiatives 



Laredo, Texas 

Program: 
Contact: 
Phone: 
Start Date: 



Periodic Immunization Clinics 
Lisa Sanford 
(210)723-2051 
01-01-90 



Target Population: 

The local population is 95 percent Hispanic, and approximately 48 percent live below poverty level. 
Many of the school children are temporary residents who come from Mexico for the school year then 
return. Upon arrival in Laredo, the vast majority lack all immunizations and must begin each series from 
the beginning. There are constant barriers of parental consent because the parents are often in Mexico 
and unable to sign or give the ^propriate medical history. 

Accomplishments : 
NA 

Purpose: 

Due to the extremely heavy demand for immimization services at the health department, primarily from 
children requiring boosters or vaccines in order to attend school, periodic immunization clinics are set up 
in the schools. The school district nurses are prohibited from providing immunizations per school policy; 
therefore, the two health department nurses are utilized to administer vaccines. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
Yes. 



Areas Addressed By Program: 

Health Education 
Health Services 



Funding Method: 

Local Tax Dollars 

Preventive Health Services Blk. Grant 

Title V, MCH Block Grant 

Estimated Annual Budget: 

$50,000 



169 



Source: 1995 CityMatCH Survey 



What Works m: Sdiool Healtfa in Uiban Communities 



Successful Initiatives 



Lubbock, Texas 

Program: 
Contact: 
Phone: 
Start Date: 



NA 

M. Mitchell 

(806) 767-2910 

05-01-94 



Target Population: 

Elementaiy school children. 
Accomplishments : 

978 immunized in City of Lubbock, Texas. 
Purpose: 

Established immunization programs for 42 elementary schools in the City of Lubbock. Immunized pre- 
school children in city-wide Head Start Programs. 
Has the activity been evaluated: 

Yes. Compared projected number of expected vaccinations for August with the number of vaccinations 

given in May. 
Has this initiative been tried elsewhere: 

Don't know. 



Areas Addressed By Program: 

Health Services 
Immunizations 



Funding Method: 
EPSDT 
State Funding 
City Funding 

Estimated Annual Budget: 

$5,000 



Source: 1995 CityMatCH Survey 



170 



What Woiks ni: School Health in Uiban Ctmununities 



Successful Initiatives 



San Antonio, Texas 

Program: Head Start Health Screening 

Contact: S. Wilson, M.D. 

Phone: (210) 207-8870 

Start Date: 08-01-94 



Target Population: 

Children under five years of age. 
Accomplishments : 

NA 
Purpose: 

Health screenings and follow-up of abnormalities in Head Start Children. 
Has the activity been evaluated? 

No. 
Has this initiative been tried elsewhere? 

Dcm't know. 



Areas Addressed By Program: 

Health Services 



Funding Method: 
EPSDT 

Individual School Support 
Local Tax Dollars 
Medicaid 
Title V, MCH Block Grant 

Estimated Annual Budget: 

$100,000 



171 



Source: 1995 CityMatCH Survey 



WhatWoiksin: Scfaodi Health in Urban Communities 



Success&I Initiatives 



Salt Lake City, Utah 

Program: Families & Agencies Coming Together (FACT) 

Contact: Beverly Thomley 

Phone: (801) 468-2746 

Start Date: 01-01-89 



Target Population: 

Families who have low-incomes and represent many ethnic backgrounds, particularly Asian and His- 
panic. 

Accomplishments: 

By working together in multidisciplinary teams, services have been expanded and augmented beyond 
v/hat the traditional tax dollar is able to purchase. Success stories range from pulling together 18 agen- 
cies working with one family into a common treatment plan to that of volunteers building an entire house 
for a single parent and her three children. 

Purpose: 

The FamiUes and Agencies Coming Together (FACT) schools within Salt Lake County are all Title I 
schools with low-income, highly mobile femiUes. The mission of FACT is to bring ^miUes and agencies 
together at the community and state levels by providing family-centered, culturally sensitive, community- 
based, collaborative, coordinated efficient services. 

Has the activity been evaluated? 

Yes. Academic testing, &mily and worker interviews using a standardized assessment tools. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 
Health Services 
Community Involvement 
Nutrition Services 



Funding Method: 

Local Tax Dollars 

State Social Services Funds 

Legislative Appropriation 

Estimated Annual Budget: 

$240,000 



Source: 1995 CityMatCH Survey 



172 



What Works m.- Sdwol Health in Ufban Communities 



Successful Initiatives 



Burlington, Vermont 

Program: School-Based EPSDT Health Access Program 

Contact: Sally Kershner 

Phone: (802) 863-7323 

Start Date: 09-01-94 



Target Population: 

Children on Medicaid = in&nts, preschool children and school age children. 

Accomplishments : 

Our program data shows EPSDT enrollment is 40,000 with the following percentages of Medicaid chil- 
dren seen within each age group: 

0-1 years = 99 percent (65 percent home visits, remainder through office/clinic contact) 
1-3 years = 99 percent (32 percent home visits, remainder through ofiBce/clinic contact) 
3-5 years = 99 percent (22 percent home visits, remainder through office/clinic contact) 
5-15 years = .6 percent 
13-18 years = .5 percent 
18-21 years = 24 percent (these are usually pregnant teens seen both at home and clinic) 

Purpose: 

The Vermont Department of Health's Division of Local Health is expanding its EPSDT outreach/access 
program to schools in Vermont. This program will expand capacity to assure children on Medicaid re- 
ceive ^propriate health services and that their full learning potential is not threatened by poor health, hi 
addition, this will finance school health activities in a new way with federal Medicaid dollars and free up 
local funds to reinvest in health and human services which address Vermont's "Success by Six" and 
"Success Beyond Six" objectives. This project is connected to a broader agenda between the entire 
agency of human services and department of education which has to do with enhanced collaboration and 
integration of services at the local level and combined long-term objectives that improve the status of 
children. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Livolvement 

Nutrition Services 

Physical Education 

Healthy School Environment 

Health Promotion for Staff 



Funding Method: 



EPSDT 



Estimated Annual Budget: 

$500,000 



173 



Source: 1995 CityMatCH Survey 



What Wotks m: Sdiool Health in Uiban Communities 



Successful Initiatives 



Alexandria, Yirginia 

Contact: Dailiyl Jas{)er 

Phone: 703-838-4400 

Program: Condom Availability Program (CAP) 

Start Date: 09-01-93 



Target Population: 

Minnie Howard School for 9th graders and T.C. WiUiams High School for grades 10 through 12. 

Accomplishments: 

In September, 1993, the Alexandria PubUc Schools System implemented the Condom Availabihty Pro- 
gram in two schools, Minnie Howard School for Ninth Graders and the T.C. W^ams High School for 
grades ten through 12. The program was started with an increasing awareness of the vulnerability of 
teenagers to STDs including HTV/AIDS. This program included education and counseling on HIV/ 
ADDS/STD through enhancement of the Family Life Curriculum currently offered in grades six through 
12, stressing abstinence, prevention and risk education. 

Purpose: 

A year campaign by the Alexandria P.T.A. Council with support from the Alexandria Health Department 
allowed the Condom Availability Program to be adopted by the Alexandria School for implementation in 
the fell semester of 1993. 

In 1992, the "Virginia Health Department reported that there were 32 HTV positive persons and two cases 
of AIDS in the 13 to 19 age group detected. In the 20 to 29 age group, there were 463 HIV positive 
persons and 123 cases of AIDS diagnosed in \^rginia in 1992. Recognizing that AIDS has a long 
incubation period, the perscHis with AIDS in the 20 to 29 age group may have been infected in their 
adolescence. The number of persons who are HIV positive is unknown and estimates may be five times 
as high as reported cases. 

Has the activity been evaluated? 

Yes. George Washington University master's students evaluated the program with a student survey in- 
strument. 

Has this initiative been tried elsewhere? 

Yes. New York City Public Schools, Washington, D.C. Public Schools, and Atlanta, Georgia. 



Areas Addressed By Program: 

Health Education 
Health Services 
Community Involvement 
Nutrition Services 
Physical Education 
Career Planning Relationships 



Funding Method: 

Individual School Support 
Local Health Department 
State Tax Dollars 

Estimated Annual Budget: 

$3,800 



Source: 1995 CityMatCH Survey 



174 



What Works m: School Health in Urban Cmnmunities 



Successful Initiatives 



Portsmouth, Virginia 

Program: Second MMR for Sixth Graders 

Contact: Carol Canada, R.N. 

Phone: (804) 393-8585 

Start Date: 01-01-90 

Target Population: 

6th graders. 
Accomplishments : 

All fifth graders' immunization records received for second MMR. Those identified in need received 
MMR at the clinic site, or were referred to the health department. Public health nurses and school nurses 
administered MMR shots to fifth graders with tremendous success. 

Purpose: 

W^th the new state law requiring all children entering the sixth grade to have documented proof of receiv- 
ing two measles vaccines, the pubUc health nurses and school nurses set up a schedule so that every 
school that had fifth graders would have MMR clinics. 

Has the activity been evaluated? 
Don't know. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Services 



Funding Method: 

Local Health Department 
State Health Department 
Federal Dollars for Immunization 

Estimated Annual Budget: 

NA 



175 



Source: 1995 CityMatCH Survey 



What Works m: SdKX>l Health in LMmui Commuiiities 



Success&l Initiatives 



Yirginia Beach, Virginia 

Program: Immunizaticms at Kindergarten 

Contact: Anna Pratt 

Phone: (804)427-4281 

Start Date: 01-01-94 

Target Population: 

Preschool children. 

Accomplishments : 

First day of school many more children were immunized. 

Purpose: 

The goal of this program is to improve the immmiization levels of preschools so they would be adequately 
immunized on the first day of school. PubUc health nurses worked with the school nurses and administra- 
tion to set up special immunization climes for school enterers. Joint advertising occurred. We will 
continue this activity on an annual basis. 

Has the activity been evaluated? 
NA 

Has this initiative been tried elsewhere? 
NA 



Areas Addressed By Program: 



NA 



NA 



Funding Method: 



Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



176 



What Works m: Sdiool Health in Urban Communities 



Successful Initiatives 



Seattle, Washington 

Program: Seattle Teen Health Centers 

Contact: Anne Curtis 

Phone: (206) 296-4987 

Start Date: 01-01-89 

Target Population: 

High school, middle and alternative school students. 
Accomplishments: 

The first center was started in 1988. Its success convinced poUcy leaders, students, school staff and 
parents that teen health centers play a vital role in efforts to improve the health of adolescents. Four 
additional teen health centers opened successfully during the 1992-93 school year Feedback from 
parents, students and school staff continues to be very positive and supportive. During the 1993-94 
school year, 3,000 students were enrolled in the teen health centers, and approximately 8,000 visits were 
made to the teen health centers. 

After the third year, 68 percent of the students at Ranier Beach High School had enrolled in the teen health 
center, and 52 percent had used teen health center services. 

Purpose: 

Five teen health centers located in Seattle PubUc Schools provide comprehensive services including medi- 
cal care, mental health services, health education and referrals to community providers. Three additional 
teen health centers will open in 1995. The overall goal of the teen health centers is to increase the access 
of adolescents to quaUty health care by providing comprehensive services on a school campus. 
The centers are located in high schools. Many also serve students from nearby middle or alternative 
schools. Services are provided through collaborative partnerships of health service and mental health 
agencies. Currently 18 agencies are involved at the eight teen health center sites. Each site has a desig- 
nated lead agency. Sites are funded through the Families and Education Levy, City general frmds, private 
funds and in-kind donations. The health department is responsible for overall coordination and monitor- 
ing of the project, and provides ongoing technical assistance to each teen health center 

Has the activity been evaluated? 
Yes. 

Has this initiative been tried elsewhere? 

Yes. More schools are adding the program as funds become available. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 

Healthy School Environment 

Health Promotion for Staff 



Funding Method: 

Local Tax Dollars 
Medicaid 

Private Foundations 
Private Insurance (including HMO) 
Federal Weed/Seed Funds 
Inkind from Health Social Services 
Title V, MCH Block Grant 
(w/Tltle V funding agency) 

Estimated Annual Budget: 

$850,000 



177 



Source: 1995 CityMatCH Survey 



What Woiks m: School Health in IMmii Communities 



Successful Initiatives 



Spokane, Washington 

Program: Mental Health Counseling/Training. 

Contact: Lyndia Void 

Phone: (509) 324-1528 

Start Date: 09-01-94 

Target Population: 

Populaticm targeted has been identified by school districts as having and displaying high-risk behaviors. 
Accomplishments: 

Major accomphshment was getting primary prevention mental health services into the schools, rather 

than the usual intervention once problems have occurred. 
Purpose: 

Established mental health counseling services in local school district to provide primary prevention for a 

variety of adolescent health issues. Services provided by community mental health agency. 
Has the activity been evaluated? 

No. Currently in progress. 
Has this initiative been tried elsewhere? 

Don't know. 



Areas Addressed By Program: 

Counseling & Psychological Services 



Funding Method: 

State Tax Dollars 

Estimated Annual Budget: 

$20,300 



Source: 1995 CityMatCH Survey 



178 



What Worics m: Sdwol Health in Urban Communities 



Successfiil Initiatives 



Tacoma, Washington 

Program: Family Support Centers 

Contact: Amadeo Tiam 

Phone: (206)591-6487 

Start Date: 06-01-94 



Target Population: 

Families 
AccompUslunents : 

It is expected that assisting children and their famiUes to meet their basic needs and resolve conflicts will 

contribute to children's readiness for learning and minimize risky behaviors that lead to serious health 

problems. 

Combined activities of assessment, poUcy development and assurance at our five &mily support centers 

opened in 1994 are: 2,233 contacts, 429 meetings and 3,464 services. 

Purpose: 

The Family Support Centers bring together multidisciplinary teams of service providers fi"om pubUc and 
private agencies and community leaders and volunteers to deal with barriers that affect children's perfor- 
mance in school. 

Has the activity been evaluated? 

No. The department is in the process of developing an evaluation plan to evaluate process and short term 
and long-term effects. 

Has this initiative been tried elsewhere? 
NA 



Areas Addressed By Program: 

Health Education 
Community Involvement 
Nutrition Services 
Health Promotion for Staff 



Funding Method: 

Individual School Support 
Local Tax Dollars 
State Social Service Funds 
Community Agencies 
General State Funds 

Estimated Annual Budget: 

$884,000 



179 



Source: 1995 CityMatCH Survey 



WhatWcHlcsin: School Health in Urban Communities 



Successfiil Initiatives 



Madison, Wisconsin 

Program: 

Contact: Cheryl Robinson 

Telephone: (608)246-4516 
Start Date: 



Target Population: 

Elementary school children. 
Accomplishments : 

Five immunization clinics were held in elementary schools throughout the city. 

Purpose: 

The Madison Department of Public Health works closely with the Madison Metropolitan School District 
to ensure school children are fiilly immunized. Strategies include informing school nurses of regularly 
planned immunization clinics in schools, sharing immunization records and conducting special immuni- 
zation clinics in the schools. In the &11 of 1994, five clinics were held in elementary schools throughout 
the city. At these clinics, school nurses worked to ensure that children behind on immunizations attended 
the clinic. They also worked with health department nurses to assess individual immunization records, to 
screen for contradictions, to educate parents about the vaccines, and to provide the immunizations. 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Services 



Funding Method: 

Local Tax Dollars 

Estimated Annual Budget: 

NA 



Source: 1995 CityMatCH Survey 



180 



What Wofks m: School Heahh in Urban Communities 



Successful Initiatives 



MUwaukee, Wisconsin 

Program: Adolescent School Health Program 

Contact: Elizabeth Zelazek 

Phone: (414) 286-3606 

Start Date: 09-01-93 



Target Population: 

Middle Schools and High Schools. 

Accomplishments : 

A dedicated and specialized team has developed this program in collaboration wdth school personnel, 
other health department personnel, the community and private providers. Direct results have been mea- 
sured through improved high levels of cUent satisfection. Public Health Nurse satis&ction is high as 
measured by lower staff turnover and increased job satisfaction. Principle satisfaction has been measured 
by survey. 

Purpose: 

In September of 1993, the pubUc health nursing school service was reorganized. Throughout most of its 
history, the health department had delivered school service through it's generalized health nurse service, 
with a registered nurse serving in homes, clinics and schools. The reorganization took existing resources 
and refocused two nursing positions into an adolescent school health program, serving middle and high 
school students. 

This reorganization has allowed for improved identification of adolescent health needs and improved 
planning for intervention models. Specific modules of service have been and continue to be developed 
(pregnancy prevention, pregnancy education, HTV education, etc.). 

Has the activity been evaluated? 
No. 

Has this initiative been tried elsewhere? 
Don't know. 



Areas Addressed By Program: 

Health Education 

Health Services 

Counseling & Psychological Services 

Community Involvement 



Funding Method: 

Local Tax Dollars 
Title V, MCH Block Grant 
(w/Title V funding agency) 

Estimated Annual Budget: 

$450,000 



181 



Source: 1995 CityMatCH Survey 



SECTION IV 



APPENDICES 



Annual CityMatCH Survey of Urban Maternal and Child Health 
1994 Focus: School Health in Urban Communities 

Winter 1 994 

This year's annual CityMatCH Survey of Urban MCH focuses on the links between local health departments 
and schools in urban communities. Information collected from this survey will form the basis for the next 
volume in the CityMatCH What Works series, which highlights successful and Innovative local health 
department programs and activities. 

This survey has two parts: 

Part 1 asks for information about your urban health department's current involvement with the schools in 
your community. Questions in this section focus on the relationships between urban health departments 
and schools, the level of health department involvement with schools, sources of authority, areas of 
involvement including school-based health centers, and barriers which prevent effective relationships with 
schools. Include information about all your health department's school health activities, not just activities 
of your MCH program. 

Part 2 updates information on health department organization, leadership, and funding provided by city and 
county health departments in previous surveys. This information is used to maintain the CityMatCH Urban 
MCH Information System, a resource available to you and others in the public health community. Part 2 also 
contains a series of questions to help CityMatCH plan and implement future activities 

The survey is to be completed by the person who Is most knowledgeable about your health department's 
maternal and child health activities. The individuals involved most with school health should have an 
opportunity to review and contribute to the survey. We also encourage you to solicit input from others in 
your health department, including your Health Director, so that the answers represent the views of your 
health department. 

Even if you are unable to answer some questions, please return the questionnaire. 

A self addressed envelope is provided. Please attach any additional materials you believe will facilitate your 
responses to the questions. If you have any questions about this survey, please contact Elice Hubbert, at 
(402) 559-8323 (FAX: (402) 559-5355). Thank you for your participation. 

PLEASE RETURN THE SURVEY BY JANUARY 6. 1995 TO: CityMatCH at the 

Department of Pediatrics 
University of Nebraska Medical Center 
600 South 42nd Street 
Omaha, NE 68198-2170 

Health Department: 

City: State 



Name of person who completed the questionnaire and can answer questions about it: 

Name: 

Position/Title: 

Address: 



City: State: Zip: 

Telephone: FAX: 



DATE COMPLETED: 



PART I: URBAN HEALTH DEPARTMENTS (UHDs) AND SCHOOLS 



1 . Relationships. Listed below are common relationships between health departments and schools. In 
the current school year, what types of relationships does your health department have with the schools 
(Grades Pre-K through 1 2) within its jurisdiction? For each type of relationship please check whether 
your health department has an on-going relationship, a relationship on request, or no relationship with 
each type of school (Public, Non-Public, Other/Alternative). Check (X) all that apply. 



Type of Relationship 
Between UHD and School 



PUBUC 

Schools 



NON-PUBUC 
SCHOOLS 



Other/ 

Alternative 

Schools 



Assurance 



Regulation, inspection, and/or certification. 



D on-going 
D on request 
D no relationship 



D orv-going 
D on request 
D no relationship 



n on-going 
D on request 
D no relationship 



Technical assistance and/or training of faculty, staff, and 
parent groups. 



n on-going 
D on request 
D no relationship 



D on-going 
D on request 
D no relationship 



D on-going 
D on request 
D no relationship 



Assist with curriculum development. 



n on-going 
D on request 
D no relationship 



D on-going 
D on request 
D no relationship 



D on-going 
D on request 
D no relationship 



Health services delivery under contract. 



D on-going 
D on request 
D no relationship 



D on-going 
D on request 
D no relationship 



D on-going 
D on request 
D no relationship 



Direct health services delivery. 



D on-going 
D on request 
D no relationship 



D on-going 
D on request 
D no relationship 



D on-going 
D on request 
D no relationship 



Collaboration on special projects. 



Monitoring and Assessment 



Surveillance and/or monitoring. 



D on-going 
D on request 
D no relationship 



D on-going 
D on request 
D no relationship 



D on-going 
D on request 
D no relationship 



D on-going 
D on request 
D no relationship 



D on-going 
D on request 
D no relationship 



D on-going 
D on request 
D no relationship 



Needs assessment/planning for services. 



Policy Development 



Development of policies/written guidelines related to health. 



Other. Please identify: 



D on- 
D on 
D no 



D on- 
D on 
D no 



n on- 
D on 
D no 



going 

request 

relationship 



going 

request 

relationship 



going 

request 

relationship 



n on-going 
D on request 
D no relationship 



D on-going 
n on request 
D no relationship 



D on-going 
D on request 
D no relationship 



D 
D 
D 



on-going 
on request 
no relationship 



n on-going 
D on request 
D no relationship 



n on-going 
n on request 
D no relationship 



Other. Please identify: 



D on- 
n on 
D no 



going 

request 

relationship 



D on-going 
D on request 
D no relationship 



D 
D 
D 



on-gomg 
on request 
no relationship 



n No current involvement with any schools 







D Unknown/Don't Know 



2. Areas of Urban Health Department Involvement in Comprehensive School Health Programs. 
For each of the eight areas of comprehensive school health, check (X) the grade levels your health 
department is involved with in any of the schools in its jurisdiction. For each area provide examples of 
the types of services your health department provides. Attach additional sheets if necessary. If this 
information is unknown please check here D and go to page 5. 



Health Education: providing a planned, sequential instructional program that addresses the physical, 
mental, emotional and social dimensions of health. The curriculum is designed to motivate and 
assist students to maintain and improve their health, prevent disease, and reduce health-related risk 
behaviors. It allows students to develop and demonstrate increasingly sophisticated health-related 
knowledge, attitudes, skills, and practices. A variety of topics such as: personal health, family 
health, community health, consumer health, environmental health, sexuality education, mental and 
emotional health, injury prevention and safety, nutrition, prevention and control of disease, and 
substance use and abuse are included. 



Pre-K a 



Grade Levels Where Involved 
Elementary School □ Middle School □ 



High School □ 



Examples: 



Health Services: providing services to insure access and/or referral to primary health care services, 
foster appropriate use of primary health care services, prevent and control communicable disease 
and other health problems, and provide emergency care for illness or injury. Screening, diagnosis 
and treatment are frequently performed as well as case management. 



Pre-K n 



Grade Levels Where Involved 
Elementary School □ Middle School o 



High School □ 



Examples: 



Counseling and Psychological Services: providing services which attend to the mental, emotional, 
and social health of students. Services include broad-based individual and group assessments, 
interventions, and referrals in areas such as self-control, self-esteem, and peer pressure. 



Pre-K D 



Grade Levels Where involved 
Elementary School n Middle School o 



High School n 



Examples: 



Community Involvement: fostering an integrated school, parent, and community approach which 
establishes a dynamic partnership to enhance the health and well-being of students. 


Pre-K D 


Grade Levels Where Involved 
Elementary School Q Middle School □ High School □ 


Examples: 

1 



Continued on next page. 



Nutrition Services: services which 
to nutritious and appealing meals. 


promote the health and education of students by providing access 


Pre-K □ 


Grade Levels Where Involved 
Elementary School □ Middle School □ 


High School a 


Examples: 



Hea/t/iy Scliool Environment: services affecting the physical and aesthetic surroundinjgs, and the 
psycho-social climate and culture of the school which maximize the health of students and staff. 
Factors that influence the physical environment include the school building, and the area surrounding 
it, any biological or chemical agents that may be detrimental to health, and physical conditions such 
as temperature, noise, and lighting. The psychological environment includes the interrelated 
physical, and psychological safety, positive interpersonal relationships, recognition of the needs and 
successes of the individual, and support for building self-esteem in students and staff. 



Pre-K □ 



Grade Levels Where Involved 
Elementary School □ Middle School □ 



High School □ 



Examples: 



Physical Education: providing planned, sequential, age-appropriate programs that promote cognitive 
content and learning experiences in a variety of activity areas such as: basic movement skills; 
physical fitness; games; team, dual, and individual sports. Quality physical education should further 
each student's optimum physical, mental, emotional, and social development, and should promote 
activities and sports which students can enjoy and pursue throughout their lives to improve their 
overall health status and reduce stress. 



Pre-K n 



Grade Levels Where Involved 
Elementary School o Middle School □ 



High School □ 



Examples: 



Health Promotion for Staff: providing health promotion programs for school staff which provide 
health assessments, health education and health-related fitness activities. Programs encourage and 
motivate all school staff to pursue healthy lifestyles, thus promoting better health, improved morale, 
and a greater personal commitment to the school's overall comprehensive health program. 



Pre-K □ 



Grade Levels Where Involved 
Elementary School □ Middle School o 



High School □ 



Examples: 



Other (please describe): 


Grade Levels Where Involved 
Pre-K □ Elementary School □ Middle School □ 


High School d 


Examples: 



3. Urban Health Department Involvement With School-Based/School-Linked Health Centers 

a. School-based health centers (SBHCs) are located on school grounds and serve only that particular 
school.^ Are there any SBHCs associated with the schools in your health department's 
jurisdiction? 

D DON'T KNOW D NO 

D YES > How many SBHCs are located in your health department's jurisdiction? 

# in elementary schools # in middle schools # in high schools 

In how many SBHCs is your health department considered the lead agency? 

# in elementary schools # in middle schools # in high schools 

With how many SBHCs is your health department involved in any capacity? 
# in elementary schools # in middle schools # In high schools 

b. School-linked health centers (SLHCs) are either located on a school campus and serve more than 
one school or are located off campus (regardless of the numbers of schools served) J Are there 
any SLHCs associated with the schools in your health department's jurisdiction? 

D DON'T KNOW D NO 

D YES > How many SLHCs are located in your health department's jurisdiction? 

# in elementary schools # in middle schools # in high schools 

In how many SBHCs is your health department considered the lead agency? 

# in elementary schools # in middle schools # in high schools 

With how many SBHCs is your health department involved in any capacity? 
# in elementary schools # in middle schools # in high schools 

c. Indicate which of the following services are provided by your urban health department in a SBHC, 
a SLHC, or both. Check (X) all that apply. 

SBHC SLHC Both 

D D D Urban health department provides medical services (Examples include: 

providing immunizations; vision, hearing, or dental screenings; diagnosis and treatment 
of minor and acute problems; management of chronic problems; laboratory testing; 
family planning; pregnancy testing; STD/HIV testing and treatment.) 

D D D Urban health department provides health education/promotion services 

(Examples include: one-on-one patient education; group/targeted education in areas such 
as conflict resolution; family and community health education; classroom presentations 
and resource support for school health educators.) 

D D D Urban health department provides mental health services (Examples include: 

individual mental health assessment, treatment, and follow-up; group and family 
counseling; crisis intervention.) 

D D D Urban health department provides social services (Examples include: social 

service assessment; case management.) 
D n D Other. Please describe 



' McKlnney, D.H., Peak, G.L. (1994). School-based and school-linked health centers: update 1993. Washington, DC: 
The Center for Population Options. 



4. Authority. Is your health department's involvement with any of the schools or school districts 
located within its jurisdiction mandated by law and/or formalized through a written agreement? 

D DON'T KNOW 

D NO . 

D YES > If yes, please list any such laws or written agreements and attach copies of 

relevant materials if available. (Examples: State or local public health laws or 
ordinances; State or local educational laws or ordinances; memorandums of 
understanding, etc.) 



5. Barriers. Please identify the three greatest barriers your health department has experienced in trying 
to work in collaboration with the schools in your jurisdiction. Briefly describe your health 
department's efforts at overcoming each barrier. 



Barrier 1: 



Efforts to overcome: 



Barrier 2: 



Efforts to overcome: 



Barrier 3: 



Efforts to overcome: 



6. Successful UHD Initiatives in School Health 

Describe below your health department's most successful initiative/activity involving school health. 

Contact for 

More information: Telephone: ( ) 



a. Nameof school health initiative/activity: 

b. Date initiative/activity began: 



c. Briefly describe the initiative/activity, including the demographic characteristics of the population 
served, and its major accomplishments to date. 



Continued on next page. 



Which of the eight areas of comprehensive school health programs is/are addressed by this 
initiative/activity? (See Question 2, Pages 3-4 for expanded definitions.) Check (X) all that apply. 



Health Education 

Health Services 

Counseling and Psychological Services 

Community Involvement 



Nutrition Services 
Healthy School Environment 
Physical Education 
Health Promotion for Staff 
Other. Please identify: 



e. How is the initiative/activity funded? Check (X) all that apply. 



charitable campaigns (such as United Way) 

community health centers: Section 330 PHS Act 

Community Mental Health Services Block Grant 

corporate donations 

district or diocese education office 

EPSDT 

Indian Health Service 

individual donations 

individual school support 

local social services 

local tax dollars 

Medicaid (other than EPSDT) 



Other. Please identify: 

Other. Please identify: 

patient self-pay 

Preventive Health & Health Services Block Grant 

private foundations (such as RWJ, Pew, Casey) 

private insurance (including HMO payments) 

State education agency 

State social services funds 

Social Services Block Grant (Title XX Social Security Act) 

SPRANS grant 

Substance Abuse Prevention and Treatment Block Grant 

Title X 

Title V, Maternal and Child Health Block Grant 

> If Title V funding is utilized, has your health 

department collaborated with the Title V 
funding agency in planning or other activities 
connected with the initiative? 

D DON'T KNOW 
D NO 
D YES 



f . Estimated annual cost/budget for the Initiative/activity? $ 

g. Has this initiative/activity been evaluated? 
n DON'T KNOW D NO 

D YES > If yes, please briefly describe the evaluation process and findings. 



Has this initiative been tried elsewhere? 

D DON'T KNOW D NO 

□ YES > If yes, where. 



PART 2: UPDATE OF CityMatCH URBAN MCH INFORMATION DATABASE 
1 . MCH Organization and Leadership 

a. Is the organizational structure of maternal and child health programs and activities in your 
health department the same now as it was in July 1993? Check (X) one. 
D DON'T KNOW 

D NO > If no, briefly explain how the MCH organization has changed: 

D YES 



b. Please attach your health department's most recent organizational chart. Indicate on the 
organizational chart where the MCH unit(s), if any, reside by circling the unit(s). Also mark 
"X" where the designated MCH director/leader is situated in the health department. 

c. Is the person in your health department who is considered the director or coordinator of 
Maternal and Child Health the same now as in July 1 993? Check (X) one. 

D DON'T KNOW > Skip to Page 10, Question 2. 

□ YES > Skip to Page 10, Question 2. 

□ NO i> Complete all questions below. 

D HD's FIRST CityMatCH SURVEY ► Complete all questions below 



Name: 

PosKlon: 

Address: 



City: State: Zip: 

Telephone: FAX: 



e. His/her position is: full-time part-time 

f . Number of years as MCH director or coordinator: years 

g. His/her professional degree(s): Check (X) all that apply. 

DSc, DrPH, PhD MSN MPA MD (specialty): 

RN MPH MSW Other (specify): 



h. Gender: Female Male 

i. His/her age group: Check (X) one. 

20-29 30-39 40-49 50-59 60-69 70 and over 

j. Race: Asian or Pacific Islander White 

Black/African American Other: 

Native American, Eskimo, Aleut 

k. Ethnicity: Hispanic/Latino Not of Hispanic Origin 



Financing for MCH 

a. What was vour health department's total operating budget for FY94? (Give amount in dollars.) 
$ OR Check (X) one: unknown not available 

b. Please estimate : What proportion of your health department's total operating budget for 
FY94 was dedicated to maternal and child health activities? 

% OR Check (X) one: unknown not available 

c. What were the sources of funds dedicated to MCH activities in FY94? Please estimate the 
proportion that came from each source below. If this information is not known. X here : D 

PERCENT (%) SOURCE OF FUNDS 

State MCH Block Grant 

Other grants, awards from the state 

City, county, or other local government funds 

Direct federal revenues (e.g. SPRANS projects, 330 funds, federal grants) 

Medicaid 

Reimbursement from HMO(s) or other managed care contractor(s) 

Other third party reimbursement (e.g. private or other insurance) 

Private sources (e.g. foundations, donations, corporate contributions) 

Other (please specify) : 



100% 

How are third party reimbursement dollars (insurance, Medicaid) generated by your MCH 
program activities channeled upon receipt in your health department? Check (X) all that apply. 

D They are dedicated to MCH programs 

D They go into a general fund 

D Third party dollars are not generated by our MCH activities 

D Other (specify): 



e. How did the MCH budget in your health department change between FY93 and FY94? 
increased about the same decreased unknown 

f . How will the MCH budget in your health department change between FY94 and FY95 ? 
increase about the same decrease unknown 

3. Medicaid Managed Care Update 

a. What is the current status of Medicaid managed care for the women, infants, children, and 
adolescents who reside within the jurisdiction served by your health department? Check (X) 
one. 

D Medicaid managed care is currently in place. 
D Medicaid managed care is currently being phased in. 

D Medicaid managed care will be implemented within the next twelve months. 
D Medicaid managed care will be implemented sometime in the future. 
D Medicaid managed care is currently under consideration. 
D Medicaid managed care is not being considered at this time. 
D Other - Please explain: 



D Don't Know 

10 



Urban MCH Capacity Building 

CityMatCH needs additional information to plan and implement activities to help strengthen the 
skills of urban MCH leaders, thus increasing the MCH capacity of urban city and county health 
departments. 

Following is a list of specific areas in which skills-building activities might be beneficial to urban 
MCH leaders. Please select three areas in which you think skills building activities would be most 
beneficial to you and CIRCLE THE NUMBER preceding EACH area. 



Population-based needs assessment 

Program evaluation 

Protocol and policy development 

Reaching under-served communities with unique 

service delivery methods 

Soliciting and maintaining community 

involvement 

Working with the media 

Other. Please identify: 



1 . Defining and measuring outcomes 1 0. 

2. Developing funding strategies 1 1 . 

3. Developing effective media campaign 12. 
strategies 1 3. 

4. Developing quality assurance programs 

5. Drafting/developing legislation for 14. 
submission to local legislatures 

6. Grant writing and other funding solicitation 1 5. 

7. Incorporating cultural competence into pro- 16. 
gram design/operation 

8. Organizing and maintaining community 
coalitions 

9. Organizing and training interdisciplinary 
teams 

CityMatCH wants to broker inter-city /county networking for technical assistance. List the numbers 
of up to three areas from the preceding list (question 4a above) or identify up to three other areas 
in which you would be willing to provide technical assistance to urban MCH colleagues in other 
urban communities. 



17. Other. Please identify: 



# 



# 



Other areas; please identify: 



Following are ways to provide technical assistance to you and/or your health department. Indicate 
your preference for each method by circling a number from 1 to 5 with "1 = Least Helpful" to "5 
= Most Helpful." 



Least 



Information on Audiotapes 

Information on CD ROM 

Packets of written info, about a particular topic 
Video teleconference sessions (interactive) . . . 
Videotaped presentations (non-interactive) . . . 

Teleconference calls 

CityMatCH preconference workshops 

Other workshops of 1 day or less 

Training Institute of 2 or more days 

Site visits to other cities 

Visits of technical assistance teams to your city 
Other: Please identify 



2 
2 
2 
2 
2 
2 
2 
2 
2 
2 
2 
2 



3 
3 
3 
3 
3 
3 
3 
3 
3 
3 
3 
3 



4 
4 
4 
4 
4 
4 
4 
4 
4 
4 
4 
4 



Most 
5 
5 
5 
5 
5 
5 
5 
5 
5 
5 
5 
5 



Comments: 



11 



5. Principal MCH Problems 

Following is a list of leading MCH problems often faced by urban families. Indicate the rank order 
of these problems for the families served by your health department. The problems should be 
ranked from 1-10 relative to each other with 1 =Most Important. 



Rank 


MCH Problems 


Rank 


MCH Problems 




ACCESS TO CARE: Problems such as access 
to dental, primary, pediatric, prenatal, 
preventive health care services; 
transportation, language, and like barriers; 
financial barriers such as under and 
uninsurance; and Medicaid access. 




UNDERIMMUNIZATION OF CHILDREN: 

Problems such as lack of immunization 
services; low levels of immunization among 
two-year olds. 




ADOLESCENT PREGNANCY AND 
PARENTING: Problems such as teen 
pregnancy; teen child bearing; teen parenting. 




VIOLENCE: Problems of domestic violence; 
family violence; spouse abuse; child abuse; 
crime; and interpersonal violence. 




ADVERSE PERINATAL OUTCOMES: Problems 
of infant mortality; low birthweight, and/or 
prematurity. 




WEAKENED FAMILY SYSTEMS: problems 
involving lack of social supports; lack of male 
involvement; eroding family values. 




CLIENT KNOWLEDGE, ATTITUDES, 
PRACTICES AND BELIEFS: Problems such as 
poor parenting; lack of knowledge about 
resources and services; poor compliance/ 
missed appointments; failure to obtain care; 
poor motivation. 




WEAKENED HEALTH CARE SYSTEMS: 

Problems of poor coordination, duplication, 
and/or fragmentation of services; lack of 
comprehensive services; inadequate number of 
providers; insufficient clerical and program 
capacity to meet demand; inadequate funds to 
provide services. 




LACK OF BASIC RESOURCES: Problems such 
as poverty; inadequate or unaffordable 
housing; homelessness; unemployment; lack 
of jobs; lack of food and clothing. 




OTHER. Please identify: 




SUBSTANCE ABUSE: Problems such as 
perinatal drug and alcohol use; drug-exposed 
infants; illicit drug use; alcohol abuse; and 
tobacco use. 




OTHER. Please identify: 



per administrative use only: 
City ^ 



State 



date 1 st mailing 
date 2nd mailing 
date 3rd mailing 



date received 

org chart attached? 

materials attached? 



date coded 
date entered 
date verified 



COMMENTS: 



12 



What Woiks ID: School Health in Urban Communities 



AppendixB 



LIST OF SURVEYED HEALTH DEPARTMENTS^ 



Anchorage AK 
Binningham AL 
Huntsville AL 
Mobile AL 
Montgomery AL * 
Little Rock AR 
Phoenix AZ 
Tucson AZ 
Bakersfield CA 
Berkeley CA 
Fairfield C A 
Fresno CA 
Long Beach CA 
Los Angeles CA 
Martinez C A* 
Modesto CA 
Oakland CA 
Pasadena CA 
Riverside CA 
Sacramento CA 
Salinas CA 
San Bernardino CA 
San Diego C A 
San Francisco CA 
San Jose CA 
Santa Ana CA 
Santa Rosa CA 
Stockton C A 
Ventura CA 
Aurora CO 
Colorado Springs CO 
Denver CO 
Lakewood CO 
Bridgeport CT* 
Hartford CT * 
New Haven CT* 
Stamford CT * 
Watetbuiy CT 
Washington DC 
WihningtonDE 
Fort Lauderdale FL 
Jacksonville FL 
Miami FL 
Orlando FL • 
SL Petersburg FL 
Tallahassee FL * 
Tampa FL 
Atlanta GA 
Columbus GA 
Macon, GA 



SavaimahGA 
Honolulu HI 
Cedar Rapids lA 
Des Moines L\ * 
Boise ID 
Chicago IL 
Peoria IL 
Rockford IL 
Springfield IL * 
Evansville IN 
Fort Wayne IN * 
Gary IN 
Indianapolis IN 
South Bend IN 
Kansas City KS * 
Overland Park KS * 
TopekaKS 
Wichita KS 
Lexington KY 
Louisville KY 
Baton Rouge LA * 
New Orleans LA 
Shreveport LA 
Boston MA 
Lowell MA 
Springfield MA 
Worcester MA * 
Baltimore MD 
Portland ME 
Detroit MI 
Flint MI 

Grand Rapids MI 
Lansing MI 
Livonia MI 
Mt Clemens MI 
Ypsilanti MI 
Miimeapolis MN 
SL Paul MN 
^dependence MO 
Kansas City MO 
Springfield MO 
St Louis MO 
Jackson MS 
BiUingsMT 
Missoula MT * 
Charlotte NC 
Durham NC 
Greensboro NC 
Raleigh NC 
Winston-Salem NC 



Lincoln NE 
Omaha NE 
Manchester NH 
EUzabethNJ 
Jersey City NJ * 
Newark NJ * 
Paterson NJ 
Albuquerque NM 
Las Vegas NV 
RenoNV 
Albany NY 
Buffalo NY* 
Hawthorne NY 
New York NY 
Rochester NY 
Syracuse NY 
Akron OH 
Cinciimati OH * 
Cleveland OH 
Columbus OH 
Dayton OH 
Toledo OH 
Oklahoma City OK 
Tulsa OK 
Eugene OR 
Portland OR 
Salem OR 
Allentown PA 
Erie PA 

Philadelphia PA 
Pittsburgh PA 
San Juan PR 
Providence RI * 
Columbia SC * 
Sioux Falls SD 
Chattanooga TN * 
KnoxvilleTN 
Memphis TN 
Nashville TN 
Abilene TX 
AmarilloTX* 
Austin TX 
Beaimiont TX * 
Corpus Christi TX 
Dallas TX 
El Paso TX 
Fort Worth TX 
Garland TX 
Houston TX 
Irving TX 



Laredo TX 
Lubbock TX 
Mesquite TX 
Pasadena TX 
Piano TX 
San Antonio TX 
WacoTX* 
Salt Lake City UT 
Alexandria VA 
Chesapeake VA 
Hampton VA * 
Newport News VA 
Norfolk VA * 
Portsmouth VA 
Richmond VA 
Virginia Beach VA 
Burlington VT 
SeatUe WA 
Spokane WA 
Tacoma WA 
Madison WI 
Milwaukee WI 
Charleston WV 
Cheyenne WY * 



^ List reflects the city where the responding health department resides. 
' Did not respond to 1 995 sun/ey. 



What Works III: School Health in Urban Communities 



Appendix C 



DIRECTORY OF URBAN MCH PROGRAMS 
AND LEADERSHIP 



Promoting communication and collaboration to improve the health of urban children and families is at the heart of all 
CityMatCH activities. The "Directoiy of Urban MCH Programs and Leadership" was first pubUshed in 1990 in an effort 
to inq)rove communication among urban MCH leaders and their colleagues. The information in this directory has been 
gathered fi"om several sources, including the 1995 CityMatCH survey and the CityMatCH in-house Urban MCH 
Database. The name and tide of each health dq)artment's designated MCH director or coordinator are provided along with 
the health department name, address, and telephone and fax mmibers (if known). For health departments where no one 
person is designated as MCH director, the name of an MCH contact person is provided. These health departments are 
noted with an asterisk (*). CityMatCH hopes this updated and expanded directory will facilitate urban MCH leader's 
efforts across the country to contact their colleagues and share MCH problems and success stories. 



Anchorage, AK 

Carole McConneU, MSN, MPH 
MCH Program Manager 
Municipality of Anchorage 
Department of Health & Human Services 
P.O. Box 196650 
Anchorage, AK 99519-6650 
Phone: 907/343-6128 
FAX: 907/343-6564 

Birmingham, AL 
Tracy Hudgins 

Assistant Director of Nursing 
Clinical Services 

Jefferson County Department of Health 
1400 Sixth Avenue, P.O. Box 2648 
Birmingham, AL 35202 
Phone: 205/930-1560 
FAX: 205/930-1575 

HUNTSVILLE, AL 

Debra M. Williams, MD 

Assistant County Health OflBcer 
Madison County Health Department 

204 Eustis Avenue, P.O. Box 467 
HuntsviUe.AL 35804 

Phone: 205/539-3711 

FAX: 205/536-2084 

Mobile, AL 

Joe M. Dawsey, MPH 

Director, Family Health Clinic 
Mobik County Health Department 

251 North Bayou Street, P.O. Box 2867 
Mobae,AL 36652-2867 

Phone: 334/690-8115 

FAX: 334/690-8853 



Montgomery, AL 

Fletcher S. Bancroft 

Health Services Administrator 
Montgomery County Health Department 

3060 Mobile Highway 
Montgomery, AL 36 1 08 

Phone: 334/293-6400 

FAX: 334/293-6410 

Little Rock, AR 
Zenobia Harris 

Area VUI Manager 

Pulaski County Health Department 

200 South University Avenue, #310 
Little Rock, AR 72205 

Phone: 501/663-6080 

FAX: 501/663-1676 

Phoenix, AZ 

(Glendale, Mesa, Scottsdale, & Tempe) 

Melissa Selbst, MPH, CHES 

Director, Family Health Services 
Maricopa County Department of Public 
Health 

1 825 East Roosevelt Street 
Phoenix, AZ 85006 

Phone: 602/506-6066 

FAX: 602/506-6885 

Tucson, AZ 

Janice Nusbaum, MN, MBA, RN 
Director, PubUc Health Nursing 
Pima County Health Department 

150 West Congress 
Tucson, AZ 85701 

Phone: 520/740-8611 

FAX: 520/791-0366 



What Works ni: Sdiool Health in Urban Communities 



Appendix C 



Bakersfield, CA 

Boyce B. Diilan, MD 
Deputy Health Officer 
Director of Maternal Child Health 
Kern County Health Department 
1700 Flower Street 
Bakersfield, CA 93305-2018 
Phone: 805/861-3010 
FAX: 805/861-2018 

Berkeley, CA 

Vicki Alexander, MD. MPH 
Acting MCH Director 
Berkeley City Health Department 

2 1 80 Milvia Street, 3rd Floor 

Bericeley, CA 94704 

Phone: 510/644-7744 
FAX: 510/644-6494 

Concord, CA 
(Martinez) 

Wendel Brunner, MD, MPH 

Director of Maternal & Child Health 

Contra Costa County Health Services 

Department 

597 Center Avenue, Suite 200 

Martinez, CA 94533 

Phone: 510/313-6712 
FAX: 510/313-6721 

Fresno, CA 

Connie Woodman, RN, PHN 
Director, MCAH 
Fresno County Health Services Agency 

P.O. Box 11867 

Fresno, CA 93775 

Phone: 209/445-3307 
FAX: 209/445-3596 

Long Beach, C A 

DarrylM. Sexton, MD 

Acting MCAH Director and Health Officer 
Long Beach Department of Health & 
Human Services 
2525 Grand Avenue 
Long Beach, CA 90815-1765 
Phone: 310/570-4013 
FAX: 310/570-4049 



Los Angeles, CA 

(El Monte, Glendale, Inglewood, Pomona & 

Torrance) 

Linda Velasquez, MD, MPH 

Director, Family Child Programs 
Los Angeles County Department of 
Health Services 

241 North Figueroa, Room 306 

Los Angeles, CA 900 1 2 
Phone: 213/240-8090 
FAX: 213/893-0919 

Modesto, CA 

Cleopathia Moore, PHN, MPA 
Maternal, Child Health Director 
Stanislaus County Health Department 

2030 Coffee Road, C-4 

Modesto, CA 95355 

Phone: 209/558-7400 
FAX: 209/558-8315 

Oakland, CA 
(Fremont & Hayward) 

Jogi Khanna, MD, MPH 
MCH Director 

Alameda County Health Care Services 
Agency 

499 5th Street, Room 306 

Oakland, CA 94607 

Phone: 510/268-2628 
FAX: 510/268-2630 

OXNARD, CA 

(Ventura) 

Gary Feldman, MD 
Acting Health Officer 
Ventura County Health Department 

3161 Loma Vista Road 

Ventura, CA 93003 

Phone: 805/652-5914 
FAX: 805/652-6617 

Pasadena, CA 

Mary Margaret Rowe, RN, PHN, MSN 
Maternal Child Adolescent Health 
Coordinator 

Pasadena Health Department 
100 North Garfield Avenue, Room 140 
Pasadena, CA 91109 

Phone: 818/405-4384 
FAX: 818/405-4711 



What Woiks ID: School Heahh in Uiban Communities 



Appendix C 



Riverside, CA 

EUeenK. Taw.MD 

Director of Maternal, Child & Adolescent 
Health 

County of Riverside Health Services 
Agency, Department of Public Heatth 
4065 County Circle D, P.O. Box 7600 
Riverside, CA 92513-7600 
Phone: 909/358-5198 
FAX: 909/358-4529 

Sacramento, C A 

Pamela Jennings, PHN 
MCAH Director 

Sacramento County Department of 
Heahh & Human Services 
3701 Branch Center Road, Room 202 
Sacramento, CA 95827 
Phone: 916/366-2171 
FAX: 916/366-2388 



San Francisco, CA 
Mildred Crear 
MCAH Director 

San Francisco Department of Public 
Health 

680 - 8th Street 
San Francisco, CA 94 1 03 
Phone: 415/554-9950 
FAX: 415/554-9655 

San Jose, CA 
(Sunnyvale) 

Julie Grisham. PHN, MA 

Director, Maternal Child & Adolescent 

Health 

Santa Clara County Public Health 

976 Lenzen Avenue 

San Jose, CA 95126 

Phone: 408/299-5036 
FAX: 408/287-9793 



Salinas, CA 

Allene Mares, RN, MPH 

Chief, Family & Community Health 

Division 

Monterey County Health Department 

1 270 Nativadad Road 

Salinas, CA 93906 

Phone: 408/755-4581 
FAX: 408/757-9586 

San Bernardino, C A 
(Ontario & Rancho Cucamonga) 
Vanessa Long, PHN, MSN 
Program Manager 
San Bernardino County Health 
Department 
799 East Rialto Avenue 
San Bernardino, CA 92415-0011 
Phone: 909/383-3066 
FAX: 909/386-8181 

San Diego, C A 

(Chula Vista, Escondido, & Oceanside) 

Nancy L. Bowen, MD, MPH 
Chief, MCH 

County of San Diego Department of 
Health Services 

3581 Rosecrans, P.O. Box 85222 
San Diego, CA 92186-5222 
Phone: 619/236-4531 
FAX: 619/236-2587 



Santa Ana, C A 

(Anaheim, Fullerton, Garden Grove, 

Huntington-Beach, Irvine & Orange) 

Len Foster, MPA 

Deputy Director, Pubhc Health 

Adult-Child Health Services 

Orange County Health Care Agency 

P.O. Box 355, 515 North Sycamore 

Santa Ana, CA 92701 

Phone: 714/834-3882 
FAX: 714/834-5506 

SantaRosa,CA 

Norma EUis, BSN, MPA 

Director of Community Health 

& MCH Director 

Sonoma County Public Health 

Department 

370 Administration Drive 

Santa Rosa, C A 95403 -280 1 
Phone: 707/524-7328 
FAX: 707/524-7345 

Stockton, CA 

Susan DeMontigny, MSN, PHN 

MCAH Coordinator, MCAH Division 

San Joaquin County Public Health 

Services 

1 60 1 East Hazelton Avenue 

Stockton, CA 95205 

Phone: 209/468-0329 
FAX: 209/468-2072 



What Wnks ID: Sdiool Health in Uiban Communities 



Appendix C 



Vallejo, CA 
(Fairfield) 

Hallie W. Morrow, MD, MPH 

Maternal & Child Health Director 

Solano County Health & Social Services 

Department 

1735 Enterprise Drive 

Building 3, MS 3-220 

Fairfield, CA 94533 

Phone: 707/421-7920 
FAX: 707/421-6618 

Aurora, CO 

Maggie Gier, RNC, MS 

Associate Director of Nursing 
Tri-County Health Department 

7000 East Belleview, Suite 302 
Englewood, CO 801 1 1-1628 

Phone: 303/220-9200 

FAX: 303/220-9208 

Colorado Springs, CO 

Marilyn Bosenbecker, RN, MP A 
Nursing Director 

£1 Paso County Department of Health & 
Environment 
301 South Union Boulevard 
Colorado Springs, CO 809 1 0-3 1 23 
Phone: 719/578-3253 
FAX: 719/578-3192 

Denver, CO 

Paul Melinkovich, MD 

Associate Director, Community Health 
Services 

Denver City/County Health Department 
777 Bannock Street 
Denver, CO 80204-4507 
Phone: 303/436-7433 
FAX: 303/436-5093 

Lakewood, CO 

Mary Lou Newnam, RN, MS 

Director, Community Health Services 
Jefferson County Department of Health 
& Environment 
260 South KipUng Street 
Lakewood, CO 80226-1099 
Phone: 303/239-7001 
FAX: 303/239-7088 



Bridgeport, CT 

Roslyn Hamilton, RS, MPH 
Director of Health 
City of Bridgeport Department of Health 

752 East Main Street 
Bridgeport, CT 06608 

Phone: 203/576-7680 

FAX: 203/576-8311 

Hartford, CT 

Katherine McCormack, RN, MPH 
Director of Health 
City of Hartford Health Department 

80 Coventry Street 
Hartford, CT 06112 

Phone: 203/547-1426, Ext. 7005 

FAX: 203/722-6719 

New Haven, CT 

Nancy Paley, MPH 

Acting Director, Maternal & Child Health 
New Haven Health Department 

54 Meadow Street 

New Haven, CT 06519-1743 

Phone: 203/946-7243 

FAX: 203/946-7521 

Stamford, CT 

Olga Brown, BSN, MPH 

Director of Nursing Services 

City of Stamford Health Department 

888 Washington Boulevard 
Stamford, CT 06904-2152 

Phone: 203/977-4373 

FAX: 203/977-5882 

Waterbury, CT 

Ulder J. TiUman, MD. MPH 
Director of Health 
Public Health Department 

402 East Main Street 
Waterbury, CT 06702 

Phone: 203/574-6780 

FAX: 203/597-3481 

Washington, DC 

Barbara J. Hatcher, PhD, RN 
Acting Chief, Of5ce of MCH 
Commission of Public Health 
Department of Human Service 
800 9th Street, S.W., 3rd Floor 
Washington, DC 20024 
Phone: 202/645-5556 



What Woiks III: SdKX>l Health in Urban Communities 



Appendix C 



Wilmington, DE 
Anita Muir 

Deputy Administrator 
Division of Public Health 
Northern Health Services 
2055 Limestone Road, Suite 300 
Wilmington, DE 19808 
Phone: 302/995-8632 
FAX: 302/995-8616 



St. Petersburg, FL 

Claude M. Dharamraj, MD 
Assistant Director 
HRS Pinellas County Public Health Unit 

500 Seventh Avenue South 

P.O. Box 13549 

St. Petersburg, FL 33701 

Phone: 813/824-6921 

FAX: 813/893-5600 



Fort Lauderdale, FL 
Robert G. Self, MD 

District Medical Director 
HRS Broward County Public Health 
Unit 

2421-AS.W. 6th Avenue 
Fort Lauderdale, FL 333 1 5-26 1 3 
Phone: 305/467-4817 
FAX: 305/760-7798 



Tallahassee, FL 
Pat Snead, RN 

Senior Community Health Nurse 

Siq)ervisor 

HRS Leon County Health Department 

2965 Municipal Way 

Tallahassee, FL 32304 

Phone: 904/487-3186 
FAX: 904/487-7954 



Jacksonville, FL 

Donald R.Hagel,MD 

Director, Women's Health 
HRS-Duval County Public Health 
Division 
5322 Pearl Street 
Jacksonville. FL 32208 
Phone: 904/630-3907 
FAX: 904/354-3909 

Ml\mi,FL 
(Hialeah) 

Eleni D. Sfakianaki, MD, MSPH 
Medical Executive Director 
HRS Dade County PubUc Health Unit 

1350 N.W. 14th Street 
Miami, FL 33125 

Phone: 305/324-2401 

FAX: 305/324-5959 

Orlando, FL 

Virginia Mesa, MD, MCH 
Director of Health 
HRS Orange County PubUc Health Unit 

832 West Central Boulevard 

Orlando, FL 32805-1895 
Phone: 407/836-2656 
FAX: 407/836-2699 



Tampa, FL 

Faye S. Coe, RN 

Assistant Director 

Community Health Nursing 

HRS/Hillsborough County Health 

Department 

1 1 05 E Kennedy Boulevard 

P.O. Box 5135 

Tampa, FL 33675-5135 

Phone: 81 3/272-6200 Ext. 3068 
FAX: 813/272-5083 

Atlanta, GA 
Carol Massey 

Program Coordinator, Matemal/Family 

Plaiming 

Fulton County Health Department 

1 86 Sunset Avenue, N.W. 

Atlanta, GA 30314 

Phone: 404/730-4764 
FAX: 404/730-1290 

Columbus, GA 
Eileen Albritton 

District Clinical Coordinator 

Columbus Department of Public Health 

P.O. Box 2299 

Columbus, GA 31902-2299 
Phone: 706/321-6108 
FAX: 706/321-6126 



What Works m: School Health in Urban C<»nmiinities 



i^>pendixC 



Macon, GA 

Craig S. Lichtenwalner, MD 

Interim Health Director, District V, Unit n 
Bibb County Health Department 

81 1 Hemlock Street 

Macon, GA 31201 

Phone: 912/751-6303 
FAX: 912/751-6099 



Boise, ID 

Ruby Hawkins, RN 

Director, Family Health Services 
Central District Health Department 

707 North Armstrong Place 

Boise, ID 83704-0825 

Phone: 208/327-8580 
FAX: 208/327-8500 



Savannah, GA 
Bobbie Stough 

District Clinical Coordinator 
Chatham County Health Department 

201 1 Eisenhower Drive 

P.O. Box 14257 

Savannah, GA 31416-1257 
Phone: 912/356-2233 
FAX: 912/356-2919 

Honolulu, HI 

Nancy Kuntz, MD 

Chief, Family Health Division 

State of Hawaii Department of Health 

3652 Kilauia Avenue 

Honolulu, HI 96816 

Phone: 808/733-9018 
FAX: 808^33-8369 

Cedar Rapids, lA 
Keith Erickson 
Director 
Linn County Health Department 

501 -13th Street, N.W. 

Cedar Rapids, lA 52405-3700 
Phone: 319/398-3551 
FAX: 319/364-7391 

Des Moines, lA 

Juhus S. Conner, MD, MPH 
Public Health Director 
Polk County Health Department 

1 907 Carpenter Avenue 

Des Moines, lA 50314 

Phone: 515/286-3759 
FAX: 515/286-3082 



Chicago, IL 

Agatha Lowe, PhD 

Director 

Women & Children Health Programs 

Chicago Department of Health 

333 South State Street 

2nd Floor, DePaul Center 

Chicago, IL 60604-3972 
Phone: 312/747-9698 
FAX: 312/747-9716 ' 

Peoiua,IL 

Veronica Aberle, MSN, RN 
Assistant Director of Nursing 
Peoria City/County Health Department 

2116 North Sheridan Road 
Peoria, IL 61604 

Phone: 309/679-6012 

FAX: 309/685-3312 

ROCKFORD, IL 

Angie L. Fellows 
Director of Nurses 
Winnebago County Health Department 

401 Division Street 
Rockford,IL 61104 

Phone: 815/962-5092 

FAX: 815/962-4203 

Springfield, IL 
Anne Russell 

Nursing Administrator 

Springfield Department of Public Health 

1415 East Jeflferson Street 
Springfield, IL 62703 

Phone: 217/789-2182 

FAX: 217/789-2203 



What Wofks III: Sdiool Health in Urban Communities 



Appendix C 



EVANSVILLE, IN 

Diana Simpson 

Supervisor, Child Health CUnics 
Vanderburgh County Health Department 

Room 131, Civic Center 

1 N.W. Martin L. King Jr. Boulevard 

Evansville, IN 47708-1888 

Phone: 812/435-5871 

FAX: 812/435-5418 

Fort Wayne, IN 

Jane M. Irmscher, MD 
Health Commissioner 

Fort Wayne-Allen County Department of 
Health 

City County Building, One Main Street 
Fort Wayne, IN 46802 

Phone: 219/428-7670 
FAX: 219/427-1391 

Gary, IN 

Sharon Mitchell 
Project Director 
Project Prec-Inct 

3717 Grant Street 
Gary, IN 46408 

Phone: 219/887-5147 

FAX: 219/882-8213 

Indianapolis, IN 

Bobbie Brown, MSN 

Coordinator, Maternal and Child Health 
Health & Hospital Corporation of Marion 
county 

3838 North Rural Street, 6th Floor 
Indianapohs, IN 46205-2930 
Phone: 317/541-2341 
FAX: 317/541-2307 

South Bend, IN 

George B. Plain, MD 
Health Officer 
St Joseph County Health Department 

County-City Building, Room 825 
227 West Jefiferson Boulevard 
South Bend, IN 46601-1870 

Phone: 219/284-9750 

FAX: 219/284-9020 



TOPEKA,KS 

Nola Ahlquist-Tumer 
Clinical Director 
Topeka Shawnee County Health Agency 

1615 West 8th 

Topeka, KS 66601-0118 
Phone: 913/295-3650 
FAX: 913/295-3648 

Kansas City, KS 

Margaret Daly, ARNP, BSN, MA 

Division Head, Family Plaiming/Prenatal 
Assistant to Director, Personal Health 
Wyandotte County Health Department 
619 Ann Avenue 
Kansas City, KS 66101 

Phone: 913/573-6714 
FAX: 913/573-6729 

Overland Park, KS 
Joseph Reed, Jr., MS 

Environmental Health Officer 
Overland Park Health Department 

6300 West 87th Street 
Overland Park, KS 66212 

Topeka, KS 

Nola Ahlquist-Tumer 
Clinical Director 
Topeka Shawnee County Health Agency 

1615 West 8th 

Topeka, KS 66601-0118 

Phone: 913/295-3650 

FAX: 913/295-3648 

Wichita, KS 
Peggy Giesen 

Director of Field Services 
Wichita/Sedgwick County Health 
Department 
1900 East 9th Street 
Wichita, KS 67214 

Phone: 316/268-8443 
FAX: 316/268-8340 



What Woiks ID: Sdiool Health in Uiban Communities 



^jpendixC 



Lexington, KY 

Carla G. Cordier, RN 

Director of General Clinics 
Lexington-Fayette County Health 
Department 
650 Newtown Pike 
Lexington, KY 40508 

Phone: 616/288-2425 
FAX: 616/288-2359 

Louisville, KY 

Leslie J. Lawson, MPH, MP A 

Community Health Services Manager 
Jefferson County Heahh Department 

P.O. Box 1704 

Louisville, KY 40201-1704 
Phone: 502/574-6661 
FAX: 502/574-5734 

Baton Rouge, LA 
Sue Longoria, RN 
Nursing Siq)ervisor 
East Baton Rouge Parish Health Unit 

353 North 12th Street 

P.O. Box 3017 

Baton Rouge, LA 70802 
Phone: 504/342-1750 
FAX: 504/342-5821 

New Orleans, LA 

Susanne White, MD, MPH 
Director of Child Health 
City of New Orleans Department of 
Health 

1 300 Perdido Street, Room 8E1 3 
New Orleans, LA 70112 
Phone: 504/565-6907 
FAX: 504/565-6916 

Shreveport, la 
Eileen Shoup, RN 
Nursing Supervisor 
Caddo Parish Health Unit 

1035 Creswell 

Shreveport, LA 71101 

Phone: 318/676-5240 
FAX: 318/676-5221 



Boston, MA 

LiUian Shirley, RN, MPH 

Assistant Deputy Commissioner & 

Executive Director 

Joint Maternity Program 

Boston Department of Health & 

Hospitals 

818 Harrison Avenue 

Boston, MA 02118 

Phone: 617/534-5264 
FAX: 617/534-7165 

Lowell, MA 

Jane Benfey, MS 

Public Health Administrator 
Lowell Health Department 

50 John Street 

LoweU,MA 01852 

Phone: 508/970-4151 
FAX: 508/446-7100 

Springfield, MA 

Delores Wilhams, RN, PhD 

Commissioner of Public Health 
Springfield Public Health Department 

1414 State Street 

Springfield, MA 01109 
Phone: 413/787-6710 
FAX: 413/787-6745 

Worcester, MA 

Joseph G. McCarthy 
Director 
Worcester Health Department 

25 Meade Street 
Worcester, MA 01602 

Phone: 508/799-8531 

Baltimore, MD 

Nira Bonner, MD, MPH, FAAP 
Assistant Commissioner of Health 
Child, Adolescent/Family Health Sendees 
Baltimore City Health Department 
303 East Fayette Street, 2nd Floor 
Baltimore, MD 21202 

Phone: 410/396-1834 
FAX: 410/727-2722 



What Worics III: School Health in Urtun Communities 



Appca&xC 



Portland, ME 

Meredith L. Tipton, PhD, MPH 
Director of PubUc Health 
City of Portland Public Health Division 

389 Congress Street, Room 307 

Portland, ME 04101 

Phone: 207/874-8784 
FAX: 207/874-8913 

Ann Arbor, MI 

David R.McNutt,MD 
Director 
Washtenaw County Health Division 

555 Towner 

P.O. Box 915 

Ypsilanti,MI 48197-0915 
Phone: 313/484-6640 
FAX: 313/484-6634 

Detroit, MI 

Wihna Brakefield-Caldwell 
Health Care Administrator 
Detroit Health Department 

1151 Taylor, Room 3 17C 

Detroit, MI 48202 

Phone: 313/876-4228 
FAX: 313/876-0863 

Flint, MI 

Jenifer Murray, RN, MPH 

Director of Personal Health Services 
Genesee County Health Department 

Floyd J. McCree Courts 

Human Services Building 

630 South Saginaw Street 

Fhnt,MI 48502-1540 

Phone: 810/257-3591 
FAX: 810/257-3147 

Grand Rapids, MI 
Wanda Biennan 

Director, Community Clinical Services 
Kent County Health Department 

700 Fuller N.E. 

Grand Rapids, MI 49503 
Phone: 616/336-3002 
FAX: 616/336-4915 



Lansing, MI 

Bruce P. Miller, MPH 

Director 

Bureau of Community Health Services 

Ingham County Health Department 

5303 South Cedar Street 

P.O. Box 30161 

Lansing, MI 48909 

Phone: 517/887-4311 
FAX: 517/887-4310 

LlVONL\,MI 

Perhlure (Jean) Jackson 

Maternal Child Health Consultant 
Wayne County Health Department 

2501 South Merriman 

Westiand,MI 48185 

Phone: 313/467-3362 
FAX: 313/467-3478 

Warren, MI 
(Sterling Heights) 

Marilyn Glidden, RN 
Director 

Division of Community Health Nursing 
Macomb County Health Department 

43525 Elizabeth Road 

Mt. Clemens, MI 48043 
Phone: 810/469-5354 
FAX: 810/469-5885 

Minneapolis, MN 
Becky Mcintosh 

Acting Director 

Personal Health Services 

Minneapolis Department of Health & 

Family Support 

250 South 4th Street 

Minneapolis, MN 55415-1372 
Phone: 612/673-2884 
FAX: 612/673-2891 

St. Paul, MN 

Diane Holmgren, MBA 

Health Administration Manager 
St Paul Division of Public Health 

555 Cedar Street 

St. Paul, MN 55101 

Phone: 612/292-7712 
FAX: 612/222-2770 



What Works HI: School Health in Urfoan Communities 



Appendix C 



Independence, MO 

John B.Amadio, PhD 
Health Director 
Independence City Health Department 

223 North Memorial Drive 

Independence, MO 64050 
Phone: 816/325-7183 
FAX: 816/325-7393 

Kansas City, MO 

Sidney L. Bates, MA 
Chief MCH Services 
Kansas City MO Health Department 

1 423 East Linwood Boulevard 

Kansas City, MO 64 1 09 
Phone: 816/923-2600 
FAX: 816/861-3299 

Springfield, MO 
Rosie Sivils, RN 

Director 

Community Health Nursing Services 

Springfield/Greene County Health 

Department 

227 East Chestnut Expressway 

Springfield, MO 65802 
Phone: 417/864-1431 
FAX: 417/864-1099 



Billings, MT 

Doris Biersdorf, RD 

Director of MCH Services 
Yellowstone City/County Health 
Department 
P.O. Box 35033 
Billings, MT 59107-5033 
Phone: 406/256-6806 
FAX: 406/256-6856 

Missoula, MT 

Yvonne Bradford, RN 

Director of Health Services 

Missoula City/County Health Department 

301 West Alder Street 
Missoula, MT 59801 

Phone: 406/523-4750 

FAX: 406/523-4781 

Charlotte, NC 

Polly J. Baker, RN,MPH 
Head 

Parent, Adolescent & Child Division 
Mecklenburg County Health Department 
249 Billingsley Road 
Charlotte, NC 28211 

Phone: 704/336-6441 
FAX: 704/336-4629 



St. Louis, MO 
Larry Kettelhut 

Manager 

Maternal Child & Family Health Program 

St Louis City Department of Health & 

Hospitals 

634 North Grand Boulevard 

St. Louis, MO 63103 

Phone: 314/658-1140 
FAX: 314/658-1051 

Jackson, MS 

Ernest Griffin, MPH 
Office Director 

Office of Personal Health Services 
Mississippi State Department of Health 
P.O. Box 1700 
Jackson, MS 39215-1700 
Phone: 601/960-7463 
FAX: 601/354-6104 



Durham, NC 

Gayle Bridges Harris, RN, MPH 
Director of Nursing 
Durham County Health Department 

4 1 4 East Main Street 

Durham, NC 27701 

Phone: 919/560-7700 
FAX: 919/560-7740 

Greensboro, NC 

Earle H. Yeamans, DDS, MPH 
Director, Child Health 
Guilford County Department of Public 
Health 

1 1 00 East Wendover Avenue 
Greensboro, NC 27405 
Phone: 910/373-7537 
FAX: 910/333-6603 



What Wofks ED: SdKX>l Health in Urban Ommiunities 



Appendix C 



Raleigh, NC 

Peter J. Morris, MD, MPH 

Division Director 

MCH & Clinical Services 

Wake County Department of Health 

P.O. Box 14049 

1 Sunnybrook Road 

Raleigh, NC 27620 

Phone: 919/250-3813 
FAX: 919/250-3984 

Winston-Salem, NC 
Peggy Lemon, RN 
Nursing Director 
Forsyth County Health Department 

P.O. Box 686 

Winston-Salem, NC 27102-0686 
Phone: 910/727-8297 
FAX: 910/727-2183 

Lincoln, NE 

Carole A. Douglas,, RN, MPH 

Chief, Community Health Services 
Lincobi-Lancaster County HeaKh 
Department 
3140 "N" Street 
Lincohi,NE 68510-1514 
Phone: 402/441-8054 
FAX: 402/441-8323 

Omaha, NE 

Deborah J. Lutjen 
MCH Coordinator 
Douglas County Health Department 

Room 401 Civic Center 

1819FaniamStreet 

Omaha, NE 68183-0401 
Phone: 402/444-7209 
FAX: 402/444-6267 

Manchester, NH 

Susan Gagnon, RN, BSN 

Supervisor, Community Health Nursing 
Manchester Health Department 

795 Ebn Street 

Manchester, NH 03101 

Phone: 603/624-6466 
FAX: 603/628-6004 



Jersey City, NJ 
Joseph Castagna 

Health Officer, Board of Health 
Division of Health, City of Jersey City 

586 Newark Avenue 

Jersey City, NJ 07301 

Phone: 201/547-5545 
FAX: 201/547-6816 

Newark, NJ 

Jane Abels, MD 
Pediatrician 
Division of Community Health 

110 William Street 

Newaric,NJ 07102 

Phone: 201/733-7655 
FAX: 201/733-3648 

Paterson, NJ 

John J. Ferraioli 
Health Officer 
Paterson Health Department 

176 Broadway 

Paterson, NJ 07505 

Phone: 201/881-6924 
FAX: 201/881-3929 

Albuquerque, NM 

Maria Goldstein, MD 

District Health Officer, District I 
New Mexico Department of Health 

1111 Stanford Drive, NE. 

P.O. Box 25846 

Albuquerque , NM 87 1 25 
Phone: 505/841-4100 
FAX: 505/841-4826 

Las Vegas, NV 

Fran Courtney, RN 

Director of Clinics & Nursing Services 
Clark County Health District 

625 Shadow Lane 

P.O. Box 4426 

Las Vegas, NV 89127 

Phone: 702/383-1301 
FAX: 702/383-1446 



What Woiks III: Sdiool Heahh in Urban Communities 



Appendix C 



Reno.NV 

David E. Rice, MA, MPH 

District Health Officer 

Washoe County District Health 

Department 

1001 East Ninth Street 

P.O. Box 11 130 

Reno,NV 89520 

Phone: 702/328-2400 
FAX: 702/328-2279 

Albany, NY 

Margaret Dimanno, RN, BSN, MS 
Director of Nursing 
Albany County Department of Health 

South Ferry & Green Street 

Albany, NY 12201 

Phone: 518/447-4612 
FAX: 518/447-4573 



Syracuse, NY 

Beverly Miller, RN, MPS 

Assistant Director of Nursing 

MCH Program 

Onondaga County Health Department 

421 Montgomery Street 

Syracuse, NY 13202 

Phone: 315/435-3294 
FAX: 315/435-5720 

YONKERS,NY 

Esther H.Wender,MD 

Director, Child Health Services 

Westchester County Department of 

Health 

1 9 Bradhurst Avenue 

Hawthorne, NY 10532 

Phone: 914/593-5140 
FAX: 914/593-5090 



Buffalo, NY 

Elaine Becker, RN 
Director 

Pubhc Health Nursing Programs 
Erie County Health Department 
95 Franklin Street, Room 878 
Buffalo, NY 14202 

Phone: 716/858-7859 
FAX: 716/858-8654 

New York, NY 
Gary Butts, MD 

Deputy Commissioner 

City of New Yoric Department of Health 

125 Worth Street 

New York, NY 10013 

Phone: 212/788-5331 
FAX: 212/788-5337 

Rochester, NY 

Karin Duncan, RN, MSN 

Director, Materaal-Child Health 
Monroe County Department of Health 

111 WestfallRoad 

Caller 632, Room 976 

Rochester, NY 14692 

Phone: 716/274-6192 
FAX: 716/274-6859 



Akron, OH 

Beverly Parkman 

WIC Director/Maternal Health Supervisor 
Akron Health Department 

655 North Main Street 

Akron, OH 44310 

Phone: 216/375-2369 
FAX: 216/375-2178 

Cincinnati, OH 

Judith S. Daniels, MD, MPH 
Medical Director 
Cincinnati Health Department 

3101 Burnet Avenue 
Cincinnati, OH 45229-3098 
Phone: 513/357-7366 
FAX: 5 1 3/357-7290 or 7396 

Cleveland, OH 

Juan Molina Crespo 

Acting Commissioner of Health 
Cleveland Department of Public Health 

1925 St. Clair Avenue 

Cleveland, OH 44114 

Phone: 216/664-4372 
FAX: 216/664-2197 



What Works ID: SdKwl Health in Urban Communities 



Appendix C 



Columbus, OH 

Carolyn B. Slack, MS, RN 
Director 

Planning & Community Partnerships 
Columbus Health Department 
181 South Washington Boulevard 
Columbus, OH 43215-4096 
Phone: 614/645-6263 
FAX: 614/645-5888 

Dayton, OH 

Frederick L. Steed 
Supervisor 

Bureau Primary Health Care Services 
Combined Health District of Montgomery 
County 

451 West Third Street 
P.O. Box 972 
Dayton, OH 45422-1280 

Phone: 513/225-4966 

FAX: 513/496-3071 

Toledo, OH 
Bob Pongtana 
Project Manager 
Department of Heahh & Environment 

635 North Erie Street 
Toledo, OH 43624 

Phone: 419/245-1754 

FAX: 419/245-1696 

Oklahoma City, OK 
Loydene Cain, RN 

Program Administrator- Adult Health 
City-County Heahh Department 
of Oklahoma City 
921 N.E. 23rd Street 
Oklahoma City, OK 73105 
Phone: 405/425-4410 
FAX: 405/427-3233 

Tulsa, OK 

Joyce Reed Hollis, CNM, MS, MPH 
Division Chief of Health Services 
Tulsa City-County Health Department/ 
Central Regional Health Center 
315 South Utica 
Tulsa, OK 74104-2203 
Phone: 918/596-8427 
FAX: 918/596-8504 



Eugene, OR 

Susie Kent, RN, MS 
Nursing Supervisor 
Lane County Public Health Services 

135 East 6th 
Eugene, OR 97401 

Phone: 503/687-4013 

FAX: 503/465-2455 

Portland, OR 

Gary Oxman, MD, MPH 
Health Officer 
Multnomah County Health Division 

426 S.W.Stark, 8th Floor 
Portland, OR 92704 

Phone: 503/248-3674 

FAX: 503/248-3676 

Salem, OR 

Donalda Dodson, RN, MPH 
Manager, Public Health 
Marion County Health Department 

3 180 Center N.E. 
Salem, OR 97301 

Phone: 503/588-5357 

FAX: 503/364-6552 

Allentown, pa 

BeUe Marks, RN, MPH 
Associate Director 
Allentown Health Bureau 

245 North 6th Street 
AUentown, PA 181 02-4 1 28 

Phone: 610/437-7725 

FAX: 610/437-8799 

Erie, PA 

Charlotte Berringer 
Supervisor 
Erie County Department of HeaHh 

606 West 2nd Street 
Erie, PA 16507 

Phone: 814/451-6721 

FAX: 814/451-6767 

PmLADELPIflA, PA 

Susan Lieberman 

Interim Director, Maternal & Child Health 
Philadelphia Department of Public Health 

500 South Broad Street 
Philadelphia, PA 19146 

Phone: 215/685-6827 

FAX: 215/875-5906 



What Wofks ID: Sdiool Health in Uiiian Communities 



Appendix C 



Pittsburgh, PA 

Virginia Bowman, RN, MPH 

Chief, Maternal & Child Health Program 
Allegheny County Health Department 

542 Forbes Avenue, Suite 522 
Pittsburgh, PA 1 52 1 9-2904 
Phone: 412/350-5949 
FAX: 412/350-3779 

San Juan, PR 

Rosa Soto VeUlla, MD, MPH 

Acting Director 

Maternal & Child Health Program 

San Juan Health Department 

Apartado 21405 

Rio Piedras Station 

RioPiedras,PR 00928 

Phone: 809/751-6975 
FAX: 809/759-7527 

Providence, RI 

WiUiam HoUinshead, MD, MPH 
Medical Director 
Rhode Island Department of Health 

Three Capitol Hill, Room 302 
Providence, RI 02908-5097 
Phone: 401/277-2312 
FAX: 401/277-1442 



Chattanooga, TN 
Diana Kreider, RN 
Program Manager 

Chattanooga-Hamilton County Health 
Department 
921 East Third Street 
Chattanooga, TN 37403 
Phone: 615/209-8230 
FAX: 615/209-8210 

Knoxville,TN 

Beatrice L. Emoiy, RN, MPH 

Director of Nursing, MCN Director 
Knox County Health Department 

925 Cleveland Place, NW. 

Knoxville,TN 37917-7191 
Phone: 615/544-4114 
FAX: 615/544-4295 

Memphis, TN 

Brenda Coulehan, RN, MA 

Family Health Services Coordinator 

Memphis & Shelby County Health 

Department 

8 1 4 Jefferson Avenue 

Memphis, TN 38105 

Phone: 901/576-7888 
FAX: 901/576-7567 



Columbia, SC 

Lisa Strebler, RN, BSN 

Child Health Program Manager 

OfiSce of Nursing 

Palmetto Health District, Richland 

County Health Department 

2000 Hampton Street 

Columbia, SC 29204 

Phone: 803/929-6530 
FAX: 803/748-4993 

Sioux Falls, SD 

Charles W. Shafer, MD 

Medical Director 

Sioux River Valley Community Health 

Center/Sioux Falls City Health 

Department 

1 32 North Dakota Avenue 

Sioux FaUs,SD 57102 

Phone: 605/367-7075 
FAX: 605/367-7283 



Nashville, TN 

Betty Thompson, RN, CFNC 
Director of Nursing 
Metropolitan Health Department 

3 1 1 23rd Avenue North 

Nashville, TN 37203 

Phone: 615/340-5622 
FAX: 615/340-5665 

Abilene, TX 

Roy Willingham, MD 
Director of Health 
Abilene Taylor County Health 
Department 
P.O. Box 6489 
Abilene, TX 79608-6489 
Phone: 915/692-5600 
FAX: 915/690-6707 



What Woiks IK: Sdiool Health in Urban Communities 



Appendix C 



Amarillo,TX 
Juanita Walker 

Pediatric Nurse Practitioner 

Wyatt Community Heahh Center-NWTH 

P.O. Box 11 10 

1411 Amarillo Boulevard. East 

Amarillo,TX 79175 

Phone: 806/351-7290 

FAX: 806/351-7274 

Austin, TX 

Linda A. Welsh 

Coordinator, Early Childhood Service & 
Acting Maternal Health Coordinator 
City of Austin HHSD/Travis County 
Health Department 
P.O. Box 1088 
Austin, TX 78767 

Phone: 512/326-9210 

FAX: 512/326-9423 

Beaumont, TX 
Ingrid Fisk, MD 
Director 
Beaumont City Health Department 

950 Washington 
P.O. Box 3827 
Beaumont, TX 77704 

Phone: 409/832-4000 

Corpus Christi, TX 

Annette Sultemeier, MSN, RNCNA 
Director of Nursing 

Corpus Christi-Nueces County Health 
Department 
1702 Home Road 
Corpus Christi, TX 78416 
Phone: 512/851-7260 
FAX: 512/851-7241 

Dallas, TX 

Patsy Mitchell, RN 

Manager of Community Health Services 
City of Dallas Department of 
Environment & Health Services 
3200 Lancaster Road, Suite 230-A 
DaUas,TX 75216 

Phone: 214/670-1950 
FAX: 214/670-7539 



El Paso, TX 

Martha Quiroga, RNC, MSN 
Chief Nursing Officer 
El Paso City-County Health District 

1148 Airway 

El Paso. TX 79925 

Phone: 915/771-5748 
FAX: 915/771-5745 

Fort Worth, TX 
(Ariington) 

Glenda Thompson, RN, MSN 

Manager, Personal Health Services 
Fort Worth-Tarrant County Health 

1 800 University Drive, Room 206 

Fort Worth, TX 76107 

Phone: 817/871-7209 
FAX: 817/871-8589 

Garland, TX 

Grace Rutherford, MSN 
Medical Coordinator 
City of Garland Health Department 

P.O. Box 469002 
Garland, TX 75046-9002 
Phone: 214/205-3460 

FAX: 214/205-3505 

Houston, TX 

Sulabha Hardikar, MD 

Chief, Women's & Child Health Care 
City of Houston Health & Human 
Services Department 
8000 North Stadium Drive, 6th Floor 
Houston, TX 77054 

Phone: 713/794-9371 
FAX: 713/794-9348 

Irving, TX 

Walter Bosworth, PhD 
Director 
Irving Health Department 

825 West Irving Boulevard 
hving, TX 75060 



What Worics HI: Sdiool Health in Urban Communities 



Appendix C 



Laredo, TX 

Norma A. Diaz, RN, BSN 

Chief, Preventive Health Services 
Chy of Laredo Health Department 

2600 Cedar Avenue 

P.O. Box 2337 

Laredo, TX 78044-2337 
Phone: 210/723-2051 
FAX: 210/726-2632 

Lubbock, TX 

Mary M. Strange, RN, CNA 
Health Department Manager 
Health & Community Services Divisioii 

P.O. Box 2548 

1 902 Texas Avenue 

Lubbock, TX 79408-9961 
Phone: 806/767-2899 
FAX: 806/762-5506 

Mesqutie, TX 
John R. Skaggs 
Director 
City of Mesquite Health Department 

P.O. Box 850137 

1515 North Galloway 

Mesquite, TX 75185-0137 
Phone: 214/216-6276 
FAX: 214/216-6491 



San Antonio, TX 

Peter W. Pendergrass, MD, MPH 
Family Health Services Coordinator 
San Antonio Metro Health Department 

332 West Commerce, Room 303 
San Antonio, TX 78285-2489 
Phone: 210/207-8870 
FAX: 210/207-8999 

Waco,TX 

Sherry Williams, RN 

PubUc Health Nurse Manager 

Waco-McLennan County Public Health 

District 

225 West Waco Drive 

Waco,TX 76707 

Phone: 817/750-5460 
FAX: 817/750-5663 

Salt Lake City, UT 

Suzanne Kiiidiam, MPA 
Associate Director 
Family Health Services 
Salt Lake City-County Health 
Department 

2001 South State Street, Suite 3800 
Salt Lake City, UT 84190-2150 
Phone: 801/468-2726 
FAX: 801/468-2737 



Pasadena, TX 
Barry Price 

Chief Health Inspector 

City of Pasadena Health Department 

P.O. Box 672 
Pasadena, TX 77501 

Plano, TX 

Robert Galvan 

Director of Health & Community 

Development 

Piano Health Department 

P.O. Box 860358 

1520 Avenue K 

Piano, TX 75086-0358 
Phone: 214/578-7143 
FAX: 214/578-7142 



Alexandria, VA 
Judith H. Southard 
Director of Nursing 
Alexandria Health Department 

5 1 7 North Saint Asaph Street 
Alexandria, VA 22314 

Phone: 703/838-4384 
FAX: 703/838-4038 

Chesapeake, VA 

Nancy M. Welch, MD 
Health Director 
Chesapeake Health Department 

748 Battlefield Boulevard, North 
Chesapeake, VA 23320 

Phone: 804/547-9213 
FAX: 804/547-0298 



What Works ni: Sdiool Health in UtiMU OMiununities 



y^ipendixC 



Hampton, VA 

Carol C. Hogg, MD, MPH 
Medical Director 
Hampton Heahh Department 

P.O. Drawer C 
Hampton, VA 23669 

Phone: 804/727-6648 
FAX: 804/727-6425 



Virginia Beach, VA 

Angela B. Savage, RN 
Nurse Manager 
Virginia Beach Health Department 

3432 Virginia Beach Boulevard, Suitel03 

Virginia Beach, VA 23452 
Phone: 804/431-3450 
FAX: 804/431-3458 



Newport News, VA 

Daniel C. Warren, MD 
Director 
Newport News City Health Department 

416 J. Clyde Morris Boulevard 

Newport News, VA 23601 
Phone: 804/594-7305 
FAX: 804/594-7714 

Norfolk, VA 

Joyce L. Bollard, RN 
Nurse Manager A 
Norfoilc Department of Public Health 

401 Colley Avenue 

Norfolk, VA 23507 

Phone: 804/683-2785 
FAX: 804/683-8878 



Burlington, VT 

Patricia Berry, MPH 

Director, Division of Local Health 
Vermont Department of Heahh 
108 Cherry Street 
Burlington, VA 05402 

Phone: 802/863-7347 
FAX: 802/863-7425 

Seattle, WA 

Kathy Carson, RN 

Parent and Child Health Manager 
Seattle-King County Department of 
PubUc Heahh 

1 10 Prefontaine Place, Suite 500 
Seattle, WA 98104-2614 
Phone: 206/296-4677 
FAX: 206/296-4679 



Portsmouth, VA 

Venita Newby-Owens, MD, MPH 
Health Director 
Portsmouth Heahh District 

601 EfBngham Street, Suite 201 
Portsmouth, VA 23705 

Phone: 804/396-6819 
FAX: 804/396-6822 



Spokane, WA 
Barbara Feyh 

Director, Community & Family Services 
Spokane County Heahh Dktrict 

1101 West College Avenue 

Spokane, WA 99201 

Phone: 509/324-1617 
FAX: 509/324-1699 



RlC3iMOND, VA 

Lisa Specter 

Poject Manager 
Heahhy Start Initiative 

550 East Grace Street 

6th Street Market Place, 2nd FL 

Richmond, VA 23219 

Phone: 804/780-4191 
FAX: 804/780-4927 



Tacoma, WA 
Amadeo Tiam 

PubUc Health Manager 

Tacoma-Pierce County Heahh 

Department 

3629 South "D" Street 

Mail Stop 130 

Tacoma, WA 98408-6897 
Phone: 206/591-6487 
FAX: 206/591-7627 



What Works III: School Health in Urban Communities >^>pendix C 

Madison, WI 

Mary E. Bradley, RN, MS 

Maternal Child Health Speciahst 
Madison Department of Public Heahh 

27 1 3 East Washington Avenue 
Madison, WI 53704 

Phone: 608/246-4524 

FAX: 608/246-5619 

Milwaukee, WI 

Elizabeth Zelazek, RN, MS 

Pubhc Health Nursing Manager 

City of Milwaukee Healtli Department 

841 North Broadway, Room 228 
Milwaukee, WI 53202-3653 

Phone: 414/286-3606 

FAX: 414/286-8174 

Charleston, WV 

Rhonda L. Kennedy, RN, BSN 
Nursing Director 
Kanawha-Ciiarleston Healtli Department 

P.O. Box 927 
108 Lee Street East 
Charleston, WV 25323 

Phone: 304/348-1088 

FAX: 304/348-8149 

Cheyenne, WY 
Sue Hume, RN 
MCH Director 

Cheyenne City-Laramie County Health 
Department 
100 South Central 
Cheyenne, WY 82001 

Phone: 307/633-4000 
FAX: 603/633-4005 



What Wofks III: SdKwl Health in Urban Communities 



Appendix D 



URBAN HEALTH DEPARTMENT INVOLVEMENT 
WITH SCHOOL-BASED HEALTH CENTERS 



======== 

HEALTH 
DEPARTMENT 


ST 


NUMBER SBHCs IN 
JURISDICTION 


IS HD INVOLVED 
WITH SBHC(s) ? 


IS HD LEAD AGENCY 
INSBHC(s)? 


REGION I 










Boston 


MA 


13(H) 


YES-ALL 


YES -62% 


Lowell 


MA 


2(H) 


YES-ALL 


NO 


Springfied 


MA 


6(H3>I2£1) 


YES-ALL 


NO 


REGION n 










Paterson 


NJ 


1(H) 


YES-ALL 


NO 


New York** 


NY 


6(H4>I2) 


NO 


YES-ALL 


Rochester 


NY 


1(H) 


YES-ALL 


NO 


Syracuse 


NY 


2(E) 


YES-50% (El) 


NO 


REGION m 










Washington 


DC 


2(H) 


YES-ALL 


YES-ALL 


Wilmington 


DE 


13(H) 


YES-ALL 


YES-ALL 


Baltimore 


MD 


16(H6>I5^5) 


YES-ALL 


YES-56% 


Allentown 


PA 


2(H) 


YES-ALL 


NO 


Philadelphia 


PA 


7 (H2JS^^5) 


YES-ALL 


NO 


Pittsburgh 


PA 


16 (H6>I5JE5) 


YES-63%(H6>I133) 


NO 


Portsmouth 


VA 


1(M) 


YES-ALL 


NO 


Charleston 


WV 


2^31) 


NO 


NO 1 



LEGEND 

H=High School, M=Middle School, E=Elementary School 



**= Data Discrepancy 



What Works III: SdKwI Health in Uiban Communities 



Appendix D 



URBAN HEALTH DEPARTMENT INVOLVEMENT 
WITH SCHOOL-BASED HEALTH CENTERS 



HEALTH 
DEPARTMENT 


ST 


NUMBER SBHCs 


Is HD INVOLVED WITH 
SBHC (s) 


IS HD LEAD AGENCY 
IN SBHC (s)? 


REGION IV 










Rirmingham 


AL 


4(H2>12) 


YES-ALL 


YES-ALL 


Mobile 


AL 


1(M) 


YES-ALL 


YES-ALL 


Ft. Lauderdale 


FL 


1(M) 


NO 


NO 


Miami 


FL 


5 (H4£l) 


YES-ALL 


YES-20% (HI) 


StPetersburg 


FL 


1(H) 


YES-ALL 


YES-ALL 


Tampa 


FL 


7 (H4>1232) 


YES-ALL 


YES-86% 


Coltimbtis 


GA 


7(E) 


YES-20% (E2) 


YES-20% 


Macon 


GA 


10(E) 


YES-20% (E2) 


YES-20% 


Savamiah 


GA 


1(H) 


YES-ALL 


YES-ALL 


Lexington 


KY 


3(M2JE1) 


YES-ALL 


YES-ALL 


Louisville 


KY 


3(HI^2) 


YES-ALL 


YES-ALL 


Jackson 


MS 


1(H) 


NO 


NO 


Charlotte 


NC 


1(H) 


YES-ALL 


YES-ALL 


DuAam 


NC 


1(H) 


YES-ALL 


NO 


Greensboro 


NC 


1(H) 


YES-ALL 


YES-ALL 


Knoxville 


TN 


1(M) 


YES-ALL 


YES-ALL 


Memphis 


TN 


4(H2^2) 


YES-50% (H2) 


YES-50% (H2) 


Nashville 


TN 


1(E) 


YES-ALL 


YES-ALL 



LEGEND 

H=High School, M=Middle School, E=Elementaiy School 



**= Data Discrepancy 



What Wmks III: Sdiool Health in Urban Ctmmunities 



Appendix D 



URBAN HEALTH DEPARTMENT INVOLVEMENT 
WITH SCHOOL-BASED HEALTH CENTERS 



HEALTH 
DEPARTMENT 


ST 


NUMBER SBHCs IN 
JURISDICTION 


IS HD INVOLVED 
WHHSBHC(s)? 


IS HD LEAD AGENCY 
IN SBHC (S) ? 


REGION V 










Chicago 


IL 


6(H4,E2) 


NO 


NO 


Gary 


IN 


2(H131) 


YES-ALL 


NO 


Indianapolis 


IN 


6(H2M2£2) 


YES-ALL 


YES-33%(HlJvll) 


Detroit 


MI 


3(H2>11) 


YES-ALL 


YES-67% (H2) 


1 Flint 


MI 


3(H) 


YES-ALL 


NO 


Grand Rapids 


MI 


2(M131) 


YES-ALL 


NO 


Livonia 


MI 


2(HIJVll) 


YES-ALL 


NO 


Minneapolis 


MN 


12(H7JvI3^2) 


YES-ALL 


NO 


StPaul 


MN 


7(H) 


YES-ALL 


NO 


Cleveland 


OH 


1(H) 


YES-ALL 


NO 


Toledo 


OH 


1(E) 


NO 


NO 


Milwaukee 


WI 


2(H) 


YES-ALL 


NO 


REGION VI 










Little Rock 


AR 


6(H3avl2JEl) 


YES-ALL 


YES-ALL 


New Orleans 


LA 


3(H) 


NO 


NO 


Alberquerque 


NM 


8 (H7JVI1) 


YES-88% (H6JVI1) 


YES-ALL 


Oklahoma City 


OK 


2(H1JE1) 


NO 


NO 


Austin 


TX 


2(E) 


YES-ALL 


YES-ALL 


Dallas 


TX 


2(H) 


YES-ALL 


NO 


El Paso 


TX 


4(H1JV11^2) 


YES-50% (E2) 


NO 


Fort Worth 


TX 


2(H) 


NO 


NO 


Houston 


TX 


0** 


YES-(H4) 


YES-(H4) 


San Antonio 


TX 


5(H3JVI131) 


YES-80% (M232) 


NO 



LEGEND 

H=High School, M=Middle School, E=Elementary School **Data Discrepancy 



What WcMTks ID: SdK>ol Health in Uiban Cmnmuiiities 



^^>pendixD 



URBAN HEALTH DEPARTMENT INVOLVEMENT 
WITH SCHOOL-BASED HEALTH CENTERS 



HEALTH 
1 DEPARTMENT 


ST 


NUMBER SBHCs IN 
JURISDICTION 


IS HD INVOLVED 
WliH SBHC(S) 


IS HD LEAD AGENCY 
IN SBHC (S) 


REGION Vn 










Topeka 


KS 


2(E) 


YES-ALL 


YES-ALL 


Mdependance 


MO 


2(H131) 


YES-ALL 


NO 


Kansas City 


MO 


4(H) 


NO 


NO 


REGION VUl 










Denver 


CO 


10(H4>1135) 


YES-ALL 


YES-ALL 


REGION IX 










Phoenix 


AZ 


9 (HI 38) 


YES-ALL 


NO 


Tucson 


AZ 


9 (EIMIJES) 


YES-ALL 


NO 


Berkeley 


CA 


1(H) 


YES-ALL 


YES-ALL 


Long Beach 


CA 


4(E) 


YES-ALL 


YES-ALL 


Los Angeles 


CA 


3(H) 


NO 


NO 


Modesto 


CA 


4 (Ml 33) 


YES-ALL 


NO 


Oakland 


CA 


4(H133) 


YES-ALL 


NO 


Pasadena 


CA 


4(H) 


YES-ALL 


NO 


Sacramento 


CA 


6(E) 


YES-ALL 


NO 


San Bemadino 


CA 


2(H131) 


YES-ALL 


YES-50% (El) 


San Francisco 


CA 


2(H) 


YES-ALL 


YES-50% (HI) 


San Jose 


CA 


9 (H5M133) 


YES-ALL 


NO 


Santa Ana 


CA 


10(E) 


YES-ALL 


NO 


Santa Rosa 


CA 


1(E) 


YES-ALL 


NO 


Stockton 


CA 


3(H231) 


YES-ALL 


NO 


Honolulu** 


HI 


5(H) 


NO 


YES - 60% (H3) 



LEGEND 

H= High School, M= Middle School, E= Elementary School 



**=Data Discrepancy 



What Works ED: School Health in XJiban Communities 



AppendixD 



URBAN HEALTH DEPARTMENT INVOLVEMENT 
WITH SCHOOL-BASED HEALTH CENTERS 



= 

HEALTH 
DEPARTMENT 


ST 


NUMBER SBHCs IN 
JURISDICTION 


IS HD INVOLVED 
WITH SBHC(s)? 


Is HD LEAD AGENCY 
IN SBHC(s)? 


REGION X 










Boise 


ID 


1(E1) 


NO 


NO 


Eugene 


OR 


2 (HI) 


YES-ALL 


NO 


Portland 


OR 


7 (HI) 


YES-ALL 


YES-ALL 


Seattle 


WA 


6 (HI) 


YES-ALL 


YES-33% (H2) 


TOTAL 

79 Health Depts 


36 


321 SBHCs 
lOSEementary 
44 Middle School 
172 High School 




: :- 



LEGEND 

H=Hi^ School, M=Middle School, E=Elementary School 



**Data Discrepancy 



What Wofks III: School Health in Uifoan Communities 



Appendix E 



URBAN HEALTH DEPARTMENT INVOLVEMENT 
WITH SCHOOL-LINKED HEALTH CENTERS 



HEALTH 
DEPARTMENT 


ST* 


NUMBER SLHCs IN 
JURISDICTION 


IS HD INVOLVED 
WITHANYSLHC(S) 


IS HD LEAD AGENCY 
INANYSLHC(S)? 


REGION I 










Waterbury 


CT 


4(E) 


NO 


NO 


Portland 


ME 


3 (H132) 


YES-ALL 


YES-ALL 


REGION n 










Manchester** 


NH 


NO RESPONSE 


YES(E1) 


NO RESPONSE 


Paterson 


NJ 


2(E1JV[1) 


NO 


NO 


Syracuse 


NY 


1(H) 


NO 


NO 


San Juan 


PR 


35(H10JV[16^9) 


NO 


NO 


REGION m 










Philadelphia** 


PA 


18(H4>I6^8) 


YES(H45>I51317) 


YES-39%(H2JVI2,E3) 


Alexandria 


VA 


2(H1>I1) 


YES-ALL 


YES-ALL 


Charleston 


WV 


1(E) 


NO 


NO 


REGION IV 










Jacksonville** 


FL 


NO RESPONSE 


YES-(HlJvll31) 


NO RESPONSE 


Miami 


FL 


3(H) 


NO 


NO 


Tampa 


FL 


3(E) 






Columbus 


GA 


1(E) 






Macon 


GA 


4(M) 






Raleigh 


NC 


3 (HI, Ml, El) 


NO 


NO 



* =Including District of Columbia and Territory of Puerto Rico 

LEGEND 

H =Hi^ School, E=Elementary School 

**=Data Discrepancy: Respcmses to "With how many SLHCs is your health department involved in any capacity?" is 
inconsistent with other responses. 



What W«ks ni: Scbool Health in Uihan Communities 



^jpendixE 



URBAN HEALTH DEPARTMENT INVOLVEMENT 
WITH SCHOOL-LINKED HEALTH CENTERS 



HEALTH 
DEPARTMENT 


ST* 


NUMBER SLHCs IN 
JURISDICTION 


IS HD INVOLVED 
WITH ANY SLHC(s) 


IS HD LEAD AGENCY IN 
ANY SLHC(S)? 1 


REGION V 










Chicago** 


IL 


16(H1>I2312) 


NO RESPONSE 


YES-63%(M238) 


Indianapolis** 


IN 


2(E) 




YES-(H2Ml) 


Grand Rapids 


MI 


1(E) 


YES-ALL 


NO 


Lansing 


MI 


2(H\Ml) 


NO 


NO 


Mt. Clemens 


MI 


2(H) 


YES-ALL 


YES-ALL 


Dayton 


OH 


1(H) 


YES-ALL 


NO 


Milwaukee 


WI 


1(E) 


YES-ALL 


NO 


REGION VI 










Alberquerque 


NM 


3(H) 


YES-ALL 


YES-ALL 


Oklahoma City 


OK 


2(H131) 


NO 


NO 


Austin 


TX 


15(E) 


YES-ALL 


YES-ALL 


Fort Worth 


TX 


3(E) 


No 


NO 


Region Vn 










Wichita 


KS 


1(H) 


YES-ALL 


YES-ALL 


Region Vm 










Aurora 


CO 


3(HlJvI2) 


NO 


NO 


Lakewood 


CO 


1(M) 


NO 


NO 



*Including District of Columbia and Territory of Puerto Rico 

LEGEND 

H=High School, M=Middle School, E=Elementaiy School 

**=Data Discrepancy: Responses to "With how many SLHCs is your health department involved in any capacity?" is 

inconsistent with other responses. 



What Works III: School Health in Urban Communities 



AppendixE 



URBAN HEALTH DEPARTMENT INVOLVEMENT 
WITH SCHOOL-LINKED HEALTH CENTERS 



HEALTH 

DFPARTMFNT 


ST* 


NUMBER SLHCs IN 
TTTRTSnTCTTON 


IS HD INVOLVED 
WITH ANY ST HP rS^ 


IS HD LEAD AGENCY 
TNANYST.Hcrs^? 1 


REGION IX 










Phoenix 


AZ 


2(E) 


NO 


NO 


Tucson 


AZ 


3(H231) 


YES-ALL 


NO 


Los Angeles 


CA 


3(E) 


NO 


NO 


Pasadena 


CA 


1(H) 


NO 


NO 


Salinas 


CA 


3(M1£2) 


YES-ALL 


YES-ALL 


San Bernardino** 


CA 


(HI 32) 


YES-(H4) 


NO RESPONSE 


San Jose 


CA 


12(H2JvI238) 


YES-ALL 


YES-83%(H2JvIl£7) 


Santa Ana 


CA 


1(E) 


YES-ALL 


NO 


Santa Rosa 


CA 


1(E) 


NO 


NO 


Ventura 


CA 


9(E) 


YES-ALL 


NO 


Honolulu 


HI 


3(H) 


YES-ALL 


NO 


Reno 


NV 


2(E) 


YES-ALL 


YES-ALL 


REGION X 










Eugene 


OR 


2(H) 


YES-ALL 


NO 


Salem 


OR 


1(H) 


YES-ALL 


YES-ALL 


Tacoma 


WA 


11(E) 


NO 


NO 


TOTALS 

44 Health Depts 


28 


190 SLHCs 
47 Elementary 
38 Middle School 
105 High School 







* =Including District of Columbia and Tenitory of Puerto Rico 

LEGEND 

H =High School, M =Middle School, E =Elementary School 

**=D ata Discrepancy: Reqxmses to "With how many SLHCs is your health department involved in any capacity?" is 

inconsistent with other responses. 



m 
m 



What Works III: School Health in Urban Communities 



Appendix F 



Appendix F. Urban Health Department Services Provided (by Category) as Lead Agency in 
School Health Centers by Type of Center 



CITY 


STATE 


MEDICAL 
SVC 


HEALTH 
ED 


MENTAL 
HEALTH 


SOCIAL 
SVC 


OTHER 


BIRMINGHAM 


AL 


SBHC 


SBHC 


SBHC 


SBHC 




MOBILE 


AL 


SBHC 


SBHC 


SBHC 


SBHC 


SBHC 


LITTLE ROCK 


AR 


SBHC 


SBHC 


SBHC 


SBHC 




PHOENIX 


AZ 


BOTH 


BOTH 


BOTH 


BOTH 




TUCSON 


AZ 


BOTH 


BOTH 








BERKELEY 


CA 


SBHC 


SBHC 


SBHC 


SBHC 




LONG BEACH 


CA 


SBHC 










LOS ANGELES 


CA 










BOTH 


MODESTO 


CA 


SBHC 








SBHC 


OAKLAND 


CA 


SBHC 


SBHC 




SBHC 




PASADENA 


CA 


BOTH 


BOTH 








SACRAMENTO 


CA 


SBHC 


SBHC 




SBHC 




SALINAS 


CA 


SLHC 




SLHC 


SLHC 




SAN BERNARDINO 


CA 


BOTH 


BOTH 


SBHC 


BOTH 




SAN DIEGO 


CA 


SLHC 


SLHC 








SAN FRANCISCO 


CA 


SBHC 


BOTH 


SBHC 






SAN JOSE 


CA 


SLHC 


SLHC 


BOTH 


BOTH 




SANTA ANA 


CA 


BOTH 


BOTH 




BOTH 




SANTA ROSA 


CA 










BOTH 


STOCKTON 


CA 




SBHC 


SBHC 


SBHC 




VENTURA 


CA 


SLHC 


SLHC 






SLHC 


DENVER 


CO 


SBHC 


SBHC 






SBHC 


ENGLEWOOD 


CO 




SLHC 








LAKEWOOD 


CO 












WATERBURY 


CT 


SLHC 




SLHC 






WASHINGTON 


DC 


SBHC 


SBHC 


SBHC 


SBHC 




WILMINGTON 


DE 










SBHC 


FT LAUDERDALE 


FL 












JACKSONVILLE 


FL 










SLHC 


MIAMI 


FL 


BOTH 


BOTH 


BOTH 


BOTH 




ST. PETERSBURG 


FL 


SBHC 


SBHC 


SBHC 


SBHC 




TAMPA 


FL 


BOTH 


BOTH 


SBHC 






COLUMBUS 


GA 


SBHC 


BOTH 








MACON 


GA 


BOTH 


BOTH 








SAVANNAH 


GA 


SBHC 


SBHC 


SBHC 


SBHC 




HONOLULU 


HI 


SBHC 


BOTH 


BOTH 


BOTH 




BOISE 


ID 


SBHC 










CHICAGO 


EL 


SLHC 


SLHC 


SLHC 


SLHC 


SLHC 


PEORIA 


IL 


SBHC 


SBHC 






SBHC 



What Woiks III: School Health in Urban Communities 



Appendix F 



CITY 


STATE 


MEDICAL 
SVC 


HEALTH 
ED 


MENTAL 
HEALTH 


SOCIAL 
SVC 


OTHER 


GARY 


IN 


SBHC 


SBHC 








INDIANAPOLIS 


IN 


SBHC 


SBHC 


SBHC 


SBHC 




TOPEKA 


KS 










SBHC 


WICHITA 


KS 


SLHC 


SLHC 


SLHC 


SLHC 




LEXINGTON 


KY 


SBHC 


SBHC 


SBHC 






LOUISVILLE 


KY 


SBHC 


SBHC 


SBHC 


SBHC 




NEW ORLEANS 


LA 


SBHC 


SBHC 


NONE 


SBHC 




BOSTON 


MA 


SBHC 


SBHC 


SBHC 




SBHC 


LOWELL 


MA 










SBHC 


SPRINGFIELD 


MA 


SBHC 


SBHC 


SBHC 


SBHC 




BALTIMORE 


MD 


SBHC 


SBHC 


SBHC 


SBHC 




PORTLAND 


ME 


SLHC 


SLHC 


BOTH 


BOTH 




DETROIT 


MI 


BOTH 


BOTH 


BOTH 






FLINT 


MI 




SBHC 








GRAND RAPIDS 


MI 




SBHC 








LANSING 


MI 


SLHC 


SLHC 


SLHC 


SLHC 


SLHC 


MT CLEMENS 


MI 


SLHC 


SLHC 


SLHC 


SLHC 




WESTLAND 


MI 


BOTH 


BOTH 








MINNEAPOLIS 


MN 


SBHC 


SBHC 


SBHC 


SBHC 


SBHC 


ST. PAUL 


MN 












INDEPENDENCE 


MO 










SBHC 


KANSAS CITY 


MO 










SBHC 


JACKSON 


MS 


BOTH 










DURHAM 


NC 


SBHC 


SBHC 




SBHC 




GREENSBORO 


NC 


SBHC 


SBHC 


SBHC 


SBHC 




RALEIGH 


NC 


SLHC 


SLHC 




SLHC 


SLHC 


MANCHESTER 


NH 


SLHC 


SLHC 








PATERSON 


NJ 




BOTH 








ALBUQUERQUE 


NM 


BOTH 


BOTH 


SBHC 






RENO 


NV 


SLHC 


SLHC 




SLHC 




NEW YORK CITY 


NY 


SBHC 










ROCHESTER 


NY 


BOTH 


BOTH 






SBHC 


SYRACUSE 


NY 


SLHC 


SLHC 


SLHC 


SLHC 




CLEVELAND 


OH 




SBHC 








DAYTON 


OH 










SLHC 


TOLEDO 


OH 


SBHC 


SBHC 








OKLAHOMA CITY 


OK 












EUGENE 


OR 












PORTLAND 


OR 


SBHC 


SBHC 


SBHC 


SBHC 




SALEM 


OR 


SLHC 


SLHC 




SLHC 




ALLENTOWN 


PA 




SBHC 









What Works III: School Health in Urban Communities 



Appendix F 



CITY 


STATE 


MEDICAL 
SVC 


HEALTH 
ED 


MENTAL 
HEALTH 


SOCIAL 
SVC 


OTHER 


PHILADELPHIA 


PA 


SLHC 


BOTH 


BOTH 


SLHC 




PITTSBURGH 


PA 


BOTH 


BOTH 






BOTH 


SAN JUAN 


PR 


SLHC 


SLHC 


SLHC 


SLHC 




CHARLOTTE 


SC 


SLHC 


SLHC 






SBHC 


KNOXVILLE 


TN 


SBHC 


SBHC 


SBHC 


SBHC 




MEMPHIS 


TN 


SBHC 


SBHC 


SBHC 


SBHC 


SBHC 


NASHVILLE 


TN 


SBHC 


SBHC 


SBHC 


SBHC 




AUSTIN 


TX 


BOTH 


BOTH 


SBHC 


SBHC 




DALLAS 


TX 




BOTH 




BOTH 




EL PASO 


TX 


SBHC 










FORT WORTH 


TX 


SLHC 


SLHC 


SLHC 


SLHC 




HOUSTON 


TX 


SBHC 


SBHC 




SBHC 




SAN ANTONIO 


TX 


SBHC 






SBHC 




ALEXANDRIA 


VA 


SLHC 


SLHC 


SLHC 




SLHC 


PORTSMOUTH 


VA 


SBHC 


SBHC 








SEATTLE 


WA 


SBHC 


SBHC 


SBHC 


SBHC 




TACOMA 


WA 




SLHC 


SLHC 






MILWAUKEE 


WI 


SBHC 


SBHC 




SBHC 


SBHC 


CHARLESTON 


WV 


BOTH 


BOTH 




BOTH 





What Wofks ID: School Health in Uiban Communities i^ipendix G 

Publications/Resources Reviewed 

ACCESS to Comprehensive School-Based Health Services for Children and Youth. 1994. Experts 
Agree: Health Reform Will Affect School-Based Care . Making the Grade. The George Washington 
University. Washington, D.C. 

ACCESS to Comprehensive School-Based Health Services for Children and Youth. 1994. 
Recruiting the Right Staff: Health Centers Get Creative to Overcome Shortage of Trained 
Professionals . Making the Grade. The George Washington University. Washington, D.C. 

ACCESS to Comprehensive School-Based Health Services for Children and Youth. 1994. Special 
Supplement: National Work Groups Define School-Based Health Center Services . Columbia 
University. New York, NY. 

Adolescent Health Program. 1990. Results of the Hvpothetical State of Adolescent Health Survey 
for Hypothetical School District . Minneapolis, MN: University of Minnesota. 

Association ofState and Territorial Health Officials. 1994. ASTHO School Health Report: JiSTHO 
Endorses Position on Comprehensive School Health Programs . Washington, D.C. 

Association ofState and Territorial Health Officials. 1994. ASTHO Survey of State Primarv School 
Health Contacts: State Health Agencies and Comprehensive School Health Programs . ASTHO 
Comprehensive School Health Project. Washington, D.C. 

Behrman, Richard E, ed. 1992. The Future of Children: School Linked Services . Los Altos, CA: 
Center for the Future of Children, The David and Lucile Packard Foundation. 

Blum, Robert, et al. 1989. Technical Report on the Adolescent Health Survey . Minneapolis, MN: 
University of MN Adolescent Health Program. 

Carreon, Victoria and Wendy J. Jameson. 1993. School - Linked Service Integration in Action: 
Lessons Drawn fi-om Seven California Communities . San Francisco, CA: California Research 
Institute, San Francisco State University. 

Centers for Disease Control. 1994. School Health Policies and Programs Study TSHPPS) . Atlanta, 
GA: Division of Adolescent and School Health. 

Committee on School Health American Academy of Pediatrics. 1993. School Health: Policy and 
Practice . 5th ed. Elk Grrove Village, IL: American Academy of Pediatrics. 

Daniels, J. A. 1992-93. Report on Services . School Based Health Centers, Multnomah County 
Health Department. Portland, OR. 



What Worics III: Sdiool Health in Urban Communities Appendix G 

Dryfoos, J. G. New Frontiers in School Health Services. Current Issues in Public Health 1995. 
Hastings-on-Hudson, NY. 

Hixson, J. 1993. Developing Healthy Adolescents: Mind. Body, and Spirit . Midwest Regional 
Center for Drug-Free Schools and Communities - North Central Regional Educational Laboratory. 
Oak Brook, IL. 

Joint Statement on School Health by The Secretaries of Education and Health and Human Services. 

Marks, Ellen L. & Carolyn H. Marzke. 1993. Healthy Caring: A Process Evaluation of the Robert 
Wood Johnson Foundation's School Based Adolescent Health Care Program . Princeton, New Jersey: 
MathTech, Inc. 

Miller, D.F. 1990. Fastback 300. The Case for School-Based Health Clinics . Phi Delta Kappa 
Educational Foundation. Bloomington, IN. 

Morbidity and Mortality Weekly Report. 1994. Guidelines for School Health Programs to Prevent 
Tobacco Use and Addiction . Waltham, MA: Massachusetts Medical Society. 

State of Florida. 1993. Problem Solving and Barrier Removal in an Interagencv Collaborative 
Program . Interagency Work Group on Full Service Schools. 

The School Based Adolescent Health Care Program. The Answer Is: At School. Bringing Health 
Care to Our Students . Washington, DC. 

Stephenson, G. M. State Initiatives. 1994. School-Based Health Centers Enhance Access for Teens . 

United States Greneral Accounting Office. Report to the Chairman, Committee on Government 
Operations, House of Representatives. 1994. Health Care Reform: School-Based Health Centers 
Can Promote Access to Care . Washington, D.C. 

University of Minnesota, Division of General Pediatrics and Adolescent Health. Minnesota 
Adolescent Health Survey . 

National Consensus Building Conference on School-Linked Integrated Service Systems. Principles 
to Link by Integrating Education. Health and Human Services for Children. Youth and Families: 
Systems that are Community-Based and School-Linked Final Report 1994. 

McKinney, DebraH. & Geri Peak. 1994. School-Based and School-Linked Health Centers: Update 
1993 . The Center for population Options. 






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